Amy Ione Holle, MFT
Individual provider Active NPI Marriage & Family Therapist · Fairfax, CA
NPI 1407029291 · NPPES record last updated Apr 11, 2008
Key facts
- NPI
- 1407029291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 40489 (CA)
- Practice address
- 351 Olema Rd
Fairfax, CA 94930-1339 - Phone
- (415) 847-3112
- NPI assigned
- Apr 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Marriage and Family Therapist
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Brightside Medical PC
Practice addresses (Care Compare)
2029 Century Park E
Suite 400 Office 478
Los Angeles, CA 90067-2957
Phone (415) 360-3348
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240606004058 | CA | Practitioner - Marriage and Family Therapist | 7810439734 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40489 | CA | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 40489 | CA | Yes |
Addresses
Primary practice location
351 Olema Rd
Fairfax, CA 94930-1339
Mailing address
351 Olema Rd
Fairfax, CA 94930-1339
Phone (415) 847-3112
Other providers in Fairfax, CA
- Heidi Guilfoyle
- Yana Harootunian-Cox
- Sarah Livingston Healy
- Julia Griselda Hernandez
- Jacquie D Hoffman
- Jadyn Jim Jamora
- Elizabeth Fletcher Kelly
- Katherine Kielich
- Genevieve Elizabeth Le Goff
- Maria Therese Lee
All providers in Fairfax, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.