Provider Demographics
NPI:1528743747
Name:STINE, AMY (MAS-MFT, LAMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STINE
Suffix:
Gender:F
Credentials:MAS-MFT, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 W GILA SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3491
Mailing Address - Country:US
Mailing Address - Phone:480-282-8778
Mailing Address - Fax:
Practice Address - Street 1:7581 S WILLOW DR STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5033
Practice Address - Country:US
Practice Address - Phone:480-282-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist