Healthcare Provider Details

I. General information

NPI: 1124697438
Provider Name (Legal Business Name): ANDREW CHANG MFT-TRAINEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 SHERMAN WAY STE 200
VAN NUYS CA
91406-4458
US

IV. Provider business mailing address

5727 LA MIRADA AVE APT 203
LOS ANGELES CA
90038-2238
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-1100
  • Fax:
Mailing address:
  • Phone: 310-736-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: