Provider Demographics
NPI:1316153240
Name:TAUBER, AMY TINA (MFT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:TINA
Last Name:TAUBER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S MADISON AVE
Mailing Address - Street 2:UNIT 110
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3331
Mailing Address - Country:US
Mailing Address - Phone:626-376-8995
Mailing Address - Fax:626-432-7472
Practice Address - Street 1:1910 HUNTINGTON DR
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4812
Practice Address - Country:US
Practice Address - Phone:626-376-8995
Practice Address - Fax:626-441-6389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist