Provider Demographics
NPI:1083950307
Name:HEARN, AMBER NICHOLE (DMDT, AMFT)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:NICHOLE
Last Name:HEARN
Suffix:
Gender:F
Credentials:DMDT, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9991C COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3506
Mailing Address - Country:US
Mailing Address - Phone:951-358-4328
Mailing Address - Fax:951-358-7117
Practice Address - Street 1:1441 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4747
Practice Address - Country:US
Practice Address - Phone:909-763-4970
Practice Address - Fax:909-763-4977
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF103322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist