Provider Demographics
NPI:1518549310
Name:AMY MCDANIEL MOLINA, LLC
Entity type:Organization
Organization Name:AMY MCDANIEL MOLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MCDANIEL
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-213-2620
Mailing Address - Street 1:2409 COPPER CREST LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-2400
Mailing Address - Country:US
Mailing Address - Phone:970-213-2620
Mailing Address - Fax:
Practice Address - Street 1:323 W DRAKE RD STE 216
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8120
Practice Address - Country:US
Practice Address - Phone:720-900-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty