Healthcare Provider Details

I. General information

NPI: 1437082062
Provider Name (Legal Business Name): AMANDA ROSALES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PACIFIC COAST HWY STE 290
HERMOSA BEACH CA
90254-3283
US

IV. Provider business mailing address

1501 LINCOLN BLVD # 1115
VENICE CA
90291-3503
US

V. Phone/Fax

Practice location:
  • Phone: 424-999-4789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: