Provider Demographics
NPI:1245776855
Name:THUSTON, AMBER CHOISELLA (MSC, LPCC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CHOISELLA
Last Name:THUSTON
Suffix:
Gender:F
Credentials:MSC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4259
Mailing Address - Country:US
Mailing Address - Phone:916-266-3518
Mailing Address - Fax:
Practice Address - Street 1:948 SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605
Practice Address - Country:US
Practice Address - Phone:916-254-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5461101YP2500X
CALPCC13283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional