Ethan Caleb Amdahl, PSY.D.
Individual provider Active NPI Clinical Psychologist · Camp Pendleton, CA
NPI 1043743537 · NPPES record last updated Nov 17, 2025
Key facts
- NPI
- 1043743537
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 0810007593 (VA)
- Practice address
- 62305 8TH St.
Camp Pendleton, CA 92055-5452 - Phone
- (760) 763-6058
- NPI assigned
- Apr 11, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810007593 | VA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810007593 | VA | Yes |
Addresses
Primary practice location
62305 8TH St.
Camp Pendleton, CA 92055-5452
Mailing address
62305 8TH Street
Camp Pendleton, CA 92055-5452
Other providers in Camp Pendleton, CA
- Alexander Alba
- Noel Alba
- Leticia Isabel Alcantar
- Alice-Anne Thompson Alcorn
- David M Allen
- Paimon Ameli
- Andrew Dean Anderson
- Natalie June Anderson
- Heather Annis
- Eric Appelsies
All providers in Camp Pendleton, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.