Most Relevant Information
Provider Data
| NPI Number: | 1003639568 |
| Provider Name: | AMANDA DECKELBAUM |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/04/2024 |
| Last Updated: | 11/04/2024 |
Provider Practice Location
720 100 YEARPARTY CT
LONGMONT
CO
805048512
Practice Location Phone/Fax
| Phone: | 7204496676 |
| Fax: |
Provider Mailing Location
720 100 YEARPARTY CT
LONGMONT
CO
805048512
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |