Provider Demographics
NPI:1104593516
Name:SCRIBNER, AMY LEIGH
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:SCRIBNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 BROOKFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3541
Mailing Address - Country:US
Mailing Address - Phone:916-622-4839
Mailing Address - Fax:
Practice Address - Street 1:720 SUNRISE AVE STE 212D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4514
Practice Address - Country:US
Practice Address - Phone:916-407-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist