Healthcare Provider Details

I. General information

NPI: 1053672774
Provider Name (Legal Business Name): ANDREA LYNNE TEMPLETON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE STE 201
FRESNO CA
93711-3519
US

IV. Provider business mailing address

1690 W SHAW AVE STE 201
FRESNO CA
93711-3519
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-0482
  • Fax:
Mailing address:
  • Phone: 559-436-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70852
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: