Provider Demographics
NPI:1306680251
Name:BERRY, AMANDA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8165 TALC DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80938-9628
Mailing Address - Country:US
Mailing Address - Phone:719-291-2195
Mailing Address - Fax:
Practice Address - Street 1:8165 TALC DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80938-9628
Practice Address - Country:US
Practice Address - Phone:719-291-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional