Individual
AVERY LYNNAE AMAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5526 N ACADEMY BLVD STE 109, COLORADO SPRINGS, CO 80918-3688
(719) 301-5100
(719) 960-2649
Mailing address
5526 N ACADEMY BLVD STE 109, COLORADO SPRINGS, CO 80918-3688
(719) 301-5100
(719) 960-2649
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-285634
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790211605
—
CO
Enumeration date
09/05/2023
Last updated
09/05/2023
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