Healthcare Provider Details

I. General information

NPI: 1962202317
Provider Name (Legal Business Name): AMY BINGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N CENTRAL AVE STE 340
GLENDALE CA
91203-4238
US

IV. Provider business mailing address

3250 FAIRESTA ST APT E9
LA CRESCENTA CA
91214-2674
US

V. Phone/Fax

Practice location:
  • Phone: 424-258-4101
  • Fax:
Mailing address:
  • Phone: 719-648-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: