Basic Information
| Provider Information | |||||||||
| NPI: | 1942431846 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMY STELLA, M.A., MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9171 WILSHIRE BLVD | ||||||||
| Address2: | PENTHOUSE | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108015761 | ||||||||
| FaxNumber: | 3102731818 | ||||||||
| Practice Location | |||||||||
| Address1: | 9171 WILSHIRE BLVD | ||||||||
| Address2: | PENTHOUSE | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108015761 | ||||||||
| FaxNumber: | 3102731818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 07/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | STELLA | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | M.A., MFT | ||||||||
| AuthorizedOfficialTelephone: | 3108015761 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A., MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC47157 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.