Provider Demographics
NPI:1356523013
Name:GISBORNE, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GISBORNE
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 1:2828 COCHRAN ST STE 499
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2780
Mailing Address - Country:US
Mailing Address - Phone:747-291-5557
Mailing Address - Fax:
Practice Address - Street 1:2828 COCHRAN ST STE 499
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2780
Practice Address - Country:US
Practice Address - Phone:747-291-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist