Healthcare Provider Details

I. General information

NPI: 1497843908
Provider Name (Legal Business Name): ANDREA D STEPHENS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ SUITE 151
PACIFICA CA
94044-2654
US

IV. Provider business mailing address

80 EUREKA SQ SUITE 151
PACIFICA CA
94044-2654
US

V. Phone/Fax

Practice location:
  • Phone: 650-270-6234
  • Fax:
Mailing address:
  • Phone: 650-270-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT38739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: