Provider Demographics
NPI:1447707971
Name:AMAN, IAN (LPCC NCC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:AMAN
Suffix:
Gender:M
Credentials:LPCC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WEST MISSION ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS,
Mailing Address - State:CA
Mailing Address - Zip Code:92069
Mailing Address - Country:US
Mailing Address - Phone:760-917-1040
Mailing Address - Fax:
Practice Address - Street 1:1140 W MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1415
Practice Address - Country:US
Practice Address - Phone:760-917-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 474101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health