Provider Demographics
NPI:1679083992
Name:AMENT, ALEXANDRA (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:AMENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 S BELLAIRE ST STE 585
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4383
Mailing Address - Country:US
Mailing Address - Phone:720-442-8146
Mailing Address - Fax:
Practice Address - Street 1:1805 S BELLAIRE ST STE 585
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4383
Practice Address - Country:US
Practice Address - Phone:720-442-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005111103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid