Healthcare Provider Details

I. General information

NPI: 1053026930
Provider Name (Legal Business Name): AMALY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 05/22/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 SWEETWATER SPRINGS BLVD STE G
SPRING VALLEY CA
91978-1725
US

IV. Provider business mailing address

2615 SWEETWATER SPRINGS BLVD STE G48
SPRING VALLEY CA
91978-1709
US

V. Phone/Fax

Practice location:
  • Phone: 760-498-4160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS HALIMA EID
Title or Position: CO-CEO
Credential: LPCC
Phone: 619-841-1457