Provider Demographics
NPI:1245018522
Name:ANDREWS, LORI SUZETTE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:SUZETTE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 N COAST HWY # 1364
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1513
Mailing Address - Country:US
Mailing Address - Phone:949-204-4912
Mailing Address - Fax:
Practice Address - Street 1:668 N COAST HWY # 1364
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1513
Practice Address - Country:US
Practice Address - Phone:949-204-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37352106H00000X
CA37352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist