Basic Information
| Provider Information | |||||||||
| NPI: | 1043741630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUGER | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14211 E 4TH AVE STE 3138 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800118736 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14211 E 4TH AVE STE 3138 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800118736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202629100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC.0014866 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPCC.0014797 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.