Healthcare Provider Details

I. General information

NPI: 1881528768
Provider Name (Legal Business Name): AMELIA THAOXAOCHAY-RUIZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD
PASADENA CA
91101-6143
US

IV. Provider business mailing address

PO BOX 1012
FRESNO CA
93714-1012
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number158240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: