Provider Demographics
NPI:1689802928
Name:VAIL, AMY PANTER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:PANTER
Last Name:VAIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-0242
Mailing Address - Country:US
Mailing Address - Phone:530-581-2539
Mailing Address - Fax:
Practice Address - Street 1:1604 CHRISTY HILL ROAD
Practice Address - Street 2:
Practice Address - City:OLYMPIC VALLEY
Practice Address - State:CA
Practice Address - Zip Code:96146
Practice Address - Country:US
Practice Address - Phone:530-581-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical