Provider Demographics
NPI:1891001228
Name:AMATO, CHANNIE THAL (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:CHANNIE
Middle Name:THAL
Last Name:AMATO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3562 ALANA DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4707
Mailing Address - Country:US
Mailing Address - Phone:818-814-8344
Mailing Address - Fax:
Practice Address - Street 1:3562 ALANA DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4707
Practice Address - Country:US
Practice Address - Phone:818-814-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist