Provider Demographics
NPI:1447402920
Name:ANDRES, ALLISON LV (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LV
Last Name:ANDRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4588
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:415-497-5439
Mailing Address - Fax:
Practice Address - Street 1:4001 HIGHWAY 104 MENTAL HEALTH DEPARTMENT
Practice Address - Street 2:MULE CREEK STATE PRISON (CSP-MCSP)
Practice Address - City:IONE
Practice Address - State:CA
Practice Address - Zip Code:95640
Practice Address - Country:US
Practice Address - Phone:415-497-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY22540103TC0700X
HIPSY1123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist