Provider Demographics
NPI:1679176515
Name:MAXWELL, AMY MARISSA (LCAT, LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARISSA
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCAT, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7261
Mailing Address - Country:US
Mailing Address - Phone:720-663-1296
Mailing Address - Fax:
Practice Address - Street 1:2300 CANYON BLVD STE 7
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5619
Practice Address - Country:US
Practice Address - Phone:720-663-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017930101Y00000X
NY002488-01221700000X
CO0017549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist