Provider Demographics
NPI:1588333009
Name:AMLA FAMILY COUNSELING INC.
Entity type:Organization
Organization Name:AMLA FAMILY COUNSELING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:509-319-0845
Mailing Address - Street 1:2900 BRISTOL ST STE B320
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5987
Mailing Address - Country:US
Mailing Address - Phone:949-610-2978
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5685
Practice Address - Country:US
Practice Address - Phone:949-610-2978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty