Provider Demographics
NPI:1639717192
Name:VAN TREECK, AMBER LANE (MA, LPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LANE
Last Name:VAN TREECK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-8206
Mailing Address - Country:US
Mailing Address - Phone:207-282-1371
Mailing Address - Fax:
Practice Address - Street 1:11863 SPRINGS RD UNIT 251
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7259
Practice Address - Country:US
Practice Address - Phone:720-282-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC.0020700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional