Provider Demographics
NPI:1447419007
Name:KEITH, ANDREA MICHELE (LMFT, CEAP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MICHELE
Last Name:KEITH
Suffix:
Gender:F
Credentials:LMFT, CEAP
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 53454
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3454
Mailing Address - Country:US
Mailing Address - Phone:949-650-2442
Mailing Address - Fax:714-836-4320
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:SUITE #550, UNIVERSITYTOWER BUILDING
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-650-2442
Practice Address - Fax:714-836-4320
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45708106H00000X
CACEAP 028148171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171W00000XOther Service ProvidersContractor