Provider Demographics
NPI:1295199248
Name:HANLE, AMY SCHMIDT (BA, MS, MA, LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SCHMIDT
Last Name:HANLE
Suffix:
Gender:F
Credentials:BA, MS, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 SEABRIGHT AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2555
Mailing Address - Country:US
Mailing Address - Phone:831-824-4843
Mailing Address - Fax:
Practice Address - Street 1:1509 SEABRIGHT AVE STE C1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2555
Practice Address - Country:US
Practice Address - Phone:831-824-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120741106H00000X
CAAMFT109653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist