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General NPI Number Information
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NPI Number | 1447402920
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Entity Type | Individual
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Provider Name | ALLISON L.V. ANDRES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 4001 HIGHWAY 104 MENTAL HEALTH DEPARTMENT MULE CREEK STATE PRISON (CSP-MCSP)
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City | IONE
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State | CA
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Zip | 95640
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Country | US
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Telephone | 415-497-5439
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4588
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City | EL DORADO HILLS
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State | CA
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Zip | 95762
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Country | US
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Telephone | 415-497-5439
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22540
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1123
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License Number State | HI
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