Provider Demographics
NPI:1265777635
Name:ELLIOTT, AMY C (LMFT, MS, MTH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMFT, MS, MTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 CAMINO DEL RIO S STE 244
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3766
Mailing Address - Country:US
Mailing Address - Phone:858-208-3250
Mailing Address - Fax:
Practice Address - Street 1:2727 CAMINO DEL RIO S STE 244
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3766
Practice Address - Country:US
Practice Address - Phone:858-208-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist