Healthcare Provider Details

I. General information

NPI: 1457783748
Provider Name (Legal Business Name): AMY ANNE TEELING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

IV. Provider business mailing address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6290
  • Fax:
Mailing address:
  • Phone: 650-621-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: