Provider Demographics
NPI:1881464790
Name:PEDDY, AMBER CHRISTINE (LMFT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:CHRISTINE
Last Name:PEDDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 BELTON HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80951-9002
Mailing Address - Country:US
Mailing Address - Phone:719-238-0786
Mailing Address - Fax:
Practice Address - Street 1:5390 N ACADEMY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4064
Practice Address - Country:US
Practice Address - Phone:719-440-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1700372232Medicaid
CO1548890601Medicaid