Provider Demographics
NPI:1083971337
Name:LUSTER, AMY (MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LUSTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LUSTER
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:654 KINGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1334
Mailing Address - Country:US
Mailing Address - Phone:310-454-3013
Mailing Address - Fax:310-454-3013
Practice Address - Street 1:1460 7TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2629
Practice Address - Country:US
Practice Address - Phone:310-844-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist