Provider Demographics
NPI:1548387079
Name:ZASTROW, ANDRA E (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:E
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 W MARCH LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8211
Mailing Address - Country:US
Mailing Address - Phone:209-774-6990
Mailing Address - Fax:209-774-6990
Practice Address - Street 1:2431 W MARCH LN
Practice Address - Street 2:SUITE 210
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8211
Practice Address - Country:US
Practice Address - Phone:209-774-6990
Practice Address - Fax:209-774-6990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist