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General NPI Number Information
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NPI Number | 1366747628
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Entity Type | Individual
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Provider Name | ANDREA KAMM LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 1023 NIPOMO STREET SUITE 210
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401
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Country | US
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Telephone | 805-723-4433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406
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Country | US
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Telephone | 805-723-4433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC25021
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License Number State | CA
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