Provider Demographics
NPI:1659552602
Name:EARNHART, AMY KO (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KO
Last Name:EARNHART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:STE. 245
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-736-0231
Mailing Address - Fax:714-736-0895
Practice Address - Street 1:6301 BEACH BLVD
Practice Address - Street 2:STE. 245
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2840
Practice Address - Country:US
Practice Address - Phone:714-736-0231
Practice Address - Fax:714-736-0895
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF76868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist