Healthcare Provider Details

I. General information

NPI: 1285566190
Provider Name (Legal Business Name): AMY JACQUELYN MILLER SCHOOL PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CASUDA CANYON DR
MONTEREY PARK CA
91754-2204
US

IV. Provider business mailing address

1515 W MISSION RD APT 104
ALHAMBRA CA
91803-1618
US

V. Phone/Fax

Practice location:
  • Phone: 626-570-6220
  • Fax:
Mailing address:
  • Phone: 626-943-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240163327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: