Provider Demographics
NPI:1538424478
Name:DAVIS, AMANDA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PARFET ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5574
Mailing Address - Country:US
Mailing Address - Phone:303-232-6301
Mailing Address - Fax:310-264-6647
Practice Address - Street 1:645 PARFET ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5574
Practice Address - Country:US
Practice Address - Phone:303-232-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 30956101YM0800X
COLSW.0009922458104100000X
COCSW.099272001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker