Provider Demographics
NPI:1841518503
Name:WINCHESTER, AMY SNOW (MA, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SNOW
Last Name:WINCHESTER
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 1:13 EXNER PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4734
Mailing Address - Country:US
Mailing Address - Phone:303-587-2427
Mailing Address - Fax:
Practice Address - Street 1:5757 CENTRAL AVE
Practice Address - Street 2:#65
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2871
Practice Address - Country:US
Practice Address - Phone:303-587-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO875640Medicaid