Provider Demographics
NPI:1174486427
Name:EISENHOWER-OMHOLT, AMY J (LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:EISENHOWER-OMHOLT
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 1:2445 MORENA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4157
Mailing Address - Country:US
Mailing Address - Phone:619-507-8300
Mailing Address - Fax:
Practice Address - Street 1:2445 MORENA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4157
Practice Address - Country:US
Practice Address - Phone:619-507-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist