Provider Demographics
NPI:1003411778
Name:ANDREW, CHRISTINE THYKOOTATHIL
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:THYKOOTATHIL
Last Name:ANDREW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1502
Mailing Address - Country:US
Mailing Address - Phone:559-237-3420
Mailing Address - Fax:
Practice Address - Street 1:611 E BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1502
Practice Address - Country:US
Practice Address - Phone:559-237-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2025-02-24
Deactivation Date:2024-02-05
Deactivation Code:
Reactivation Date:2025-02-20
Provider Licenses
StateLicense IDTaxonomies
CA97224104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97224OtherMEDI-CAL