Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003208448 |
---|---|
Provider Name | Amanda Fielder |
First Address | Boulder, CO 80304-2226 |
Second Address | Boulder, CO 80304-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 23/02/2015 |