Provider Demographics
NPI:1073897534
Name:ADAMS, AMY ELIZABETH (BCABA; LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BCABA; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 IMJIN RD STE 149
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5111
Mailing Address - Country:US
Mailing Address - Phone:408-981-6245
Mailing Address - Fax:
Practice Address - Street 1:3180 IMJIN RD STE 149
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-5111
Practice Address - Country:US
Practice Address - Phone:831-786-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109392106H00000X
CA0-17-8412106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst