Provider Demographics
NPI:1598876542
Name:TRIMBLE, AMY BARKER (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BARKER
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 S MELROSE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6664
Mailing Address - Country:US
Mailing Address - Phone:760-683-4279
Mailing Address - Fax:443-681-7847
Practice Address - Street 1:450 S MELROSE DR STE 114
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6664
Practice Address - Country:US
Practice Address - Phone:760-683-4279
Practice Address - Fax:443-681-7847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00340BOtherBCBS
TX1646689-04Medicaid
TX8712BHOtherBCBS