Healthcare Provider Details

I. General information

NPI: 1588504864
Provider Name (Legal Business Name): AMBER KATHERINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16192 SISKIYOU RD STE 3
APPLE VALLEY CA
92307-1316
US

IV. Provider business mailing address

16192 SISKIYOU RD STE 3
APPLE VALLEY CA
92307-1316
US

V. Phone/Fax

Practice location:
  • Phone: 760-983-9269
  • Fax: 760-513-9919
Mailing address:
  • Phone: 760-983-9269
  • Fax: 760-513-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC19724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: