Provider Demographics
NPI:1255883179
Name:IMPERIAL BEACH COUNSELING
Entity type:Organization
Organization Name:IMPERIAL BEACH COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-737-9118
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91933-1328
Mailing Address - Country:US
Mailing Address - Phone:619-737-9118
Mailing Address - Fax:
Practice Address - Street 1:1330 ORANGE AVE STE 319
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2949
Practice Address - Country:US
Practice Address - Phone:619-737-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95732251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health