Provider Demographics
NPI:1629442108
Name:AMP FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:AMP FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-352-6850
Mailing Address - Street 1:1740 LA COSTA MEADOWS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5199
Mailing Address - Country:US
Mailing Address - Phone:808-352-6850
Mailing Address - Fax:760-591-0086
Practice Address - Street 1:1740 LA COSTA MEADOWS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5199
Practice Address - Country:US
Practice Address - Phone:808-352-6850
Practice Address - Fax:760-591-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty