Provider Demographics
NPI:1215795190
Name:DEITEL, AMIE (LMFT)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:DEITEL
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 1:665 VIA OVIEDO
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-7059
Mailing Address - Country:US
Mailing Address - Phone:858-204-1211
Mailing Address - Fax:
Practice Address - Street 1:925 BROADBECK DR STE 225
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1272
Practice Address - Country:US
Practice Address - Phone:805-628-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist