Healthcare Provider Details

I. General information

NPI: 1952841173
Provider Name (Legal Business Name): AAMBER HARRELL M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395
US

IV. Provider business mailing address

PO BOX 90326
SAN BERNARDINO CA
92427-1326
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax:
Mailing address:
  • Phone: 951-224-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: