Provider Demographics
NPI:1609595362
Name:ANDREA L STOCKER
Entity Type:Organization
Organization Name:ANDREA L STOCKER
Other - Org Name:SEASONS OF CHANGE THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-428-2776
Mailing Address - Street 1:PO BOX 2390
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-2390
Mailing Address - Country:US
Mailing Address - Phone:760-428-2776
Mailing Address - Fax:
Practice Address - Street 1:122 S GREEN ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1717
Practice Address - Country:US
Practice Address - Phone:760-428-2776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)