Provider Demographics
NPI:1063699825
Name:JAIME, AMY LYNDA (BA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNDA
Last Name:JAIME
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNDA
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1603 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-4044
Mailing Address - Country:US
Mailing Address - Phone:719-336-3647
Mailing Address - Fax:
Practice Address - Street 1:3500 1ST ST S
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-4327
Practice Address - Country:US
Practice Address - Phone:719-336-7501
Practice Address - Fax:719-336-7453
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor