Provider Demographics
NPI:1568286524
Name:AMANDA WILLETT, LLC
Entity type:Organization
Organization Name:AMANDA WILLETT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPH
Authorized Official - Phone:708-606-3994
Mailing Address - Street 1:3355 DENARGO ST UNIT 1-320
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-5361
Mailing Address - Country:US
Mailing Address - Phone:708-606-3994
Mailing Address - Fax:
Practice Address - Street 1:2727 BRYANT ST STE 610
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4153
Practice Address - Country:US
Practice Address - Phone:708-606-3994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty