Provider Demographics
NPI:1295293769
Name:ANDREW LAST FAMILY COUNSELING INC
Entity type:Organization
Organization Name:ANDREW LAST FAMILY COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-272-1522
Mailing Address - Street 1:6393 BADGER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3316
Mailing Address - Country:US
Mailing Address - Phone:619-272-1522
Mailing Address - Fax:
Practice Address - Street 1:2635 CAMINO DEL RIO S STE 211
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3729
Practice Address - Country:US
Practice Address - Phone:619-786-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912132937Medicaid