Provider Demographics
NPI:1609922566
Name:BASSATT, AMY L (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BASSATT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0001
Mailing Address - Country:US
Mailing Address - Phone:719-208-4164
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:SUITE 200G
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-208-4164
Practice Address - Fax:719-362-4067
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4830101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health