Provider Demographics
NPI:1386057644
Name:DAVIS, AMY CAMERON (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CAMERON
Last Name:DAVIS
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 1:3110 S WADSWORTH BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4810
Mailing Address - Country:US
Mailing Address - Phone:720-924-1523
Mailing Address - Fax:
Practice Address - Street 1:3110 S WADSWORTH BLVD STE 308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-4810
Practice Address - Country:US
Practice Address - Phone:720-924-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional