MEDICARE: AMY WECHSLER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780015370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WECHSLER

Provider Business Mailing Address
First Line	:	4660 EL CAJON BLVD STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4466
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 EL CAJON BLVD # 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4401
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:

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

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/03/2019

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