Provider Demographics
NPI:1871990564
Name:HERMES, AMY (LPC, LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERMES
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JULIET
Other - Last Name:KLEIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-0000
Practice Address - Country:US
Practice Address - Phone:970-328-6969
Practice Address - Fax:970-328-6329
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001215101YA0400X
COLPC.0014434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)