Provider Demographics
NPI:1154570547
Name:TUTTLE, AMY R (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:R
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1826
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1826
Mailing Address - Country:US
Mailing Address - Phone:619-850-8547
Mailing Address - Fax:619-337-2421
Practice Address - Street 1:2423 CAMINO DEL RIO S
Practice Address - Street 2:#103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3702
Practice Address - Country:US
Practice Address - Phone:619-850-8547
Practice Address - Fax:619-337-2421
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist