Provider Demographics
NPI:1194031005
Name:BOELEN, AMBER SHANAE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:SHANAE
Last Name:BOELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PLACERVILLE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4200
Mailing Address - Country:US
Mailing Address - Phone:530-644-8226
Mailing Address - Fax:530-621-9804
Practice Address - Street 1:670 PLACERVILLE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4200
Practice Address - Country:US
Practice Address - Phone:530-644-8226
Practice Address - Fax:530-621-9804
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 87930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist