Provider Demographics
NPI:1245470905
Name:DALLENBCH, AMELIA LAURENSON (MA MFC)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:LAURENSON
Last Name:DALLENBCH
Suffix:
Gender:F
Credentials:MA MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 COAST VILLAGE RD
Mailing Address - Street 2:SUITE 101, PMB #224
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2737
Mailing Address - Country:US
Mailing Address - Phone:805-895-1498
Mailing Address - Fax:
Practice Address - Street 1:539 SAN YSIDRO RD
Practice Address - Street 2:2ND FLOOR, SUITE A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2195
Practice Address - Country:US
Practice Address - Phone:805-895-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #44460106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist