Provider Demographics
NPI:1780055467
Name:ANDRES, LAUREL M (LMFT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:M
Last Name:ANDRES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E CLIFF DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4739
Mailing Address - Country:US
Mailing Address - Phone:831-475-3459
Mailing Address - Fax:
Practice Address - Street 1:2222 E CLIFF DR STE 204
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4739
Practice Address - Country:US
Practice Address - Phone:831-475-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist