Provider Demographics
NPI:1215291257
Name:JOHNSON, AMANDA KAY (MA, LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:ZIEBARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAC
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO274101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)