Basic Information
Provider Information
NPI: 1760817662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HELMSTETTER
FirstName: AMBER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MFTI
OtherOrganizationName:  
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Mailing Information
Address1: 4760 SEPULVEDA BLVD
Address2: CULVER CITY
City: CULVER CITY
State: CA
PostalCode: 902304820
CountryCode: US
TelephoneNumber: 3103906612
FaxNumber: 3103980312
Practice Location
Address1: 12420 VENICE BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900663840
CountryCode: US
TelephoneNumber: 3107511200
FaxNumber: 3103980312
Other Information
ProviderEnumerationDate: 09/10/2013
LastUpdateDate: 02/27/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X75634CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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