Provider Demographics
NPI:1740476662
Name:AUSTIN, ANDREA KIM
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KIM
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KIM
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12712 HEACOCK ST
Mailing Address - Street 2:GATEWAY COUNSELING SERVIES, SUITE 6
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-3037
Mailing Address - Country:US
Mailing Address - Phone:951-243-5576
Mailing Address - Fax:866-896-6067
Practice Address - Street 1:12712 HEACOCK ST.
Practice Address - Street 2:SUITE 6
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-3037
Practice Address - Country:US
Practice Address - Phone:951-243-5576
Practice Address - Fax:866-896-6067
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist