Individual
AMANDA J. KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
501 W BROADWAY STE A587, SAN DIEGO, CA 92101-3536
(619) 273-0129
Mailing address
501 W BROADWAY STE A587, SAN DIEGO, CA 92101-3536
(619) 273-0129
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY32361
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
09/03/2014
Last updated
04/25/2021
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