=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255141313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMOR PROPIO THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7232 EDINGER AVE
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-922-4820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2973 HARBOR BLVD # 137
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-922-4820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MISS VANESSA GUTIERREZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 562-922-4820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------