MEDICARE: CARLIE AMACHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program
4	106H00000X	Marriage & Family Therapist	119871	CA

General Provider Information

NPI Number	:	1699150664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE AMACHER

Provider Business Mailing Address
First Line	:	5530 OVERLAND AVE STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1261
Country	:	US
Telephone Number	:	619-236-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 OVERLAND AVE STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1261
Country	:	US
Telephone Number	:	619-236-2191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	10/18/2021

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Directions to “ CARLIE AMACHER ” Practice Location

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