| Amy Blackholly Consulting | |
|
25892 Vicar Way Lake Forest CA 92630-5926 | |
| (949) 350-9557 | |
| Not Available |
| Full Name | Amy Blackholly Consulting |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 25892 Vicar Way, Lake Forest, California |
| Authorized Official Name and Position | Amy Rebecca Blackholly (BEHAVIOR ANALYST) |
| Authorized Official Contact | 9493509557 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Blackholly Consulting 25892 Vicar Way Lake Forest CA 92630-5926 Ph: (949) 350-9557 | Amy Blackholly Consulting 25892 Vicar Way Lake Forest CA 92630-5926 Ph: (949) 350-9557 |
| NPI Number | 1649678269 |
|---|---|
| Provider Enumeration Date | 12/13/2014 |
| Last Update Date | 12/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649678269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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