Provider Demographics
NPI:1639377609
Name:LEMOS-MILLER, AMIE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:MARIE
Last Name:LEMOS-MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMIE
Other - Middle Name:MARIE
Other - Last Name:LEMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7745 BOULDER AVENUE #1205
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346
Mailing Address - Country:US
Mailing Address - Phone:909-830-1946
Mailing Address - Fax:
Practice Address - Street 1:7745 BOULDER AVE UNIT 1205
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-8066
Practice Address - Country:US
Practice Address - Phone:909-830-1946
Practice Address - Fax:909-864-3906
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23024103TC0700X
390200000X
CAPSY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program