Provider Demographics
NPI:1558106443
Name:ALLEN, AMY MARIE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PARKE ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1034
Mailing Address - Country:US
Mailing Address - Phone:818-667-7494
Mailing Address - Fax:
Practice Address - Street 1:380 PARKE ST APT 14
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1034
Practice Address - Country:US
Practice Address - Phone:818-667-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist