Basic Information
| Provider Information | |||||||||
| NPI: | 1417523150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMBORN | ||||||||
| FirstName: | SAXON | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1137 JULIE DR | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953482005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096289111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5362 LEMEE LN | ||||||||
| Address2: | |||||||||
| City: | MARIPOSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953389556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099662000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT125227 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.