Basic Information
| Provider Information | |||||||||
| NPI: | 1770610032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REA | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 314 N REEDER AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917243141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268594601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1215 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269740770 | ||||||||
| FaxNumber: | 6269740774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 47837 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.