Provider Demographics
NPI:1336466721
Name:NORTZ, ANDREA STEVENS (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:STEVENS
Last Name:NORTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LOCKLEY
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:47 6TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3092
Mailing Address - Country:US
Mailing Address - Phone:707-478-7026
Mailing Address - Fax:
Practice Address - Street 1:47 6TH ST STE 108
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3092
Practice Address - Country:US
Practice Address - Phone:707-478-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87036106H00000X
CAIMF74017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist