Individual
MRS. AMY MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4529 STOVER ST, FORT COLLINS, CO 80525
(303) 815-3988
Mailing address
4529 STOVER ST, FORT COLLINS, CO 80525
(303) 815-3988
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC30014160
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000155525
—
CO
Enumeration date
12/01/2017
Last updated
07/25/2019
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