Provider Demographics
NPI:1093287054
Name:KELLOGG, AMY ELIZABETH (LPCC 11032)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LPCC 11032
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25011 MAGIC MOUNTAIN PKWY APT 114
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4677
Mailing Address - Country:US
Mailing Address - Phone:507-244-0871
Mailing Address - Fax:
Practice Address - Street 1:25011 MAGIC MOUNTAIN PKWY APT 114
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4677
Practice Address - Country:US
Practice Address - Phone:507-244-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11032101YM0800X
CA6197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist