Healthcare Provider Details

I. General information

NPI: 1548065626
Provider Name (Legal Business Name): AMBER ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 REAM AVE
MOUNT SHASTA CA
96067-2539
US

IV. Provider business mailing address

PO BOX 1206
MCCLOUD CA
96057-1206
US

V. Phone/Fax

Practice location:
  • Phone: 530-423-5044
  • Fax:
Mailing address:
  • Phone: 562-325-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPPC13886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: