Healthcare Provider Details

I. General information

NPI: 1447187364
Provider Name (Legal Business Name): AMY KATHLEEN AMBRIDGE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CREEKSIDE LN
SANDPOINT ID
83864-2301
US

IV. Provider business mailing address

409 CREEKSIDE LN
SANDPOINT ID
83864-2301
US

V. Phone/Fax

Practice location:
  • Phone: 707-548-7588
  • Fax:
Mailing address:
  • Phone: 707-548-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6571737
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: