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General NPI Number Information
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NPI Number | 1831052976
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Entity Type | Individual
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Provider Name | AMIE MAHAVANH
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 39639 OLD HIGHWAY 80
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City | BOULEVARD
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State | CA
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Zip | 91905-9733
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Country | US
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Telephone | 619-766-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 39639 OLD HIGHWAY 80
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City | BOULEVARD
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State | CA
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Zip | 91905-9733
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Country | US
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Telephone | 619-766-4655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 240145966
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License Number State | CA
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