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General NPI Number Information
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NPI Number | 1396135208
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Entity Type | Organization
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Legal Business Name | ANDRADE FAMILY THERAPY
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 305 N HARBOR BLVD SUITE 215
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City | FULLERTON
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State | CA
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Zip | 92832-1990
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Country | US
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Telephone | 562-673-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N HARBOR BLVD SUITE 215
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City | FULLERTON
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State | CA
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Zip | 92832-1990
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MRS. TRACIE KELLY HOWELL-ANDRADE
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Credential | LMFT
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Telephone | 562-673-5733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 84365
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License Number State | CA
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