Healthcare Provider Details

I. General information

NPI: 1295855021
Provider Name (Legal Business Name): AMY KAY M.S., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 N FAIR OAKS AVE
PASADENA CA
91103-3050
US

IV. Provider business mailing address

14135 RIVERSIDE DR UNIT 2
SHERMAN OAKS CA
91423-2343
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-4673
  • Fax:
Mailing address:
  • Phone: 818-994-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: