Provider Demographics
NPI:1710634373
Name:FERY, AMELIE NELLY
Entity Type:Individual
Prefix:
First Name:AMELIE
Middle Name:NELLY
Last Name:FERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26895 ALISO CREEK RD # B616
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-563-3709
Mailing Address - Fax:
Practice Address - Street 1:302 N EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4778
Practice Address - Country:US
Practice Address - Phone:619-356-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62308OtherCIGNA