Provider Demographics
NPI:1558841858
Name:VANDER HYDE, ANDREA TESS (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TESS
Last Name:VANDER HYDE
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 1:1525 N ALVARADO ST UNIT 26082
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7406
Mailing Address - Country:US
Mailing Address - Phone:424-276-0831
Mailing Address - Fax:
Practice Address - Street 1:22647 VENTURA BLVD # 434
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1416
Practice Address - Country:US
Practice Address - Phone:424-276-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100217106H00000X
CA123165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100217OtherMFT (BOARD OF BEHAVIORAL SCIENCES)