Healthcare Provider Details

I. General information

NPI: 1982925418
Provider Name (Legal Business Name): ANDRALYN JODY KEYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3138 W BARSTOW AVE
FRESNO CA
93711-2603
US

IV. Provider business mailing address

7490 N WOODROW AVE
FRESNO CA
93720-0135
US

V. Phone/Fax

Practice location:
  • Phone: 559-285-9933
  • Fax:
Mailing address:
  • Phone: 559-285-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-K1307290910
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: