Provider Demographics
NPI:1396135208
Name:ANDRADE FAMILY THERAPY
Entity type:Organization
Organization Name:ANDRADE FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:HOWELL-ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-673-5733
Mailing Address - Street 1:305 N HARBOR BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 N HARBOR BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1990
Practice Address - Country:US
Practice Address - Phone:562-673-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84365251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health