Provider Demographics
NPI:1164807400
Name:CALLON, AMIE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:L
Last Name:CALLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2948
Mailing Address - Country:US
Mailing Address - Phone:310-990-3560
Mailing Address - Fax:310-545-3000
Practice Address - Street 1:2100 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2948
Practice Address - Country:US
Practice Address - Phone:310-990-3560
Practice Address - Fax:310-545-3000
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical