Provider Demographics
NPI:1821674235
Name:BLATCHLEY, ANDREA DAWN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DAWN
Last Name:BLATCHLEY
Suffix:
Gender:F
Credentials:MFT
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 631
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-0631
Mailing Address - Country:US
Mailing Address - Phone:818-321-1206
Mailing Address - Fax:
Practice Address - Street 1:34079 CASTLE PINES DR
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-6903
Practice Address - Country:US
Practice Address - Phone:818-321-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist