Provider Demographics
NPI:1366922924
Name:KALTENBACH, AMY DIANE (AMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:KALTENBACH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 PAREDO WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0133
Mailing Address - Country:US
Mailing Address - Phone:805-501-0019
Mailing Address - Fax:
Practice Address - Street 1:25000 AVENUE STANFORD UNIT 104
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1224
Practice Address - Country:US
Practice Address - Phone:818-600-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist