Provider Demographics
NPI:1558494260
Name:COOVER, AMANDA MARCELLE (MA LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARCELLE
Last Name:COOVER
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARCELLE
Other - Last Name:KIELHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2177 SHADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3461
Mailing Address - Country:US
Mailing Address - Phone:720-310-8462
Mailing Address - Fax:
Practice Address - Street 1:2177 SHADOW CREEK DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3461
Practice Address - Country:US
Practice Address - Phone:720-310-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist