Provider Demographics
NPI:1932776028
Name:STEVENS, AMBER (LMT, NBCHWC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMT, NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5530
Mailing Address - Country:US
Mailing Address - Phone:720-203-0239
Mailing Address - Fax:
Practice Address - Street 1:8795 RALSTON RD STE 202C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2357
Practice Address - Country:US
Practice Address - Phone:720-203-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3277701171400000X
COMT0008756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach