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General NPI Number Information
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NPI Number | 1942052469
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Entity Type | Individual
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Provider Name | ANDREW JOSEPH PROCHAZKA AMFT
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Gender | Male
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 23041 AVENIDA DE LA CARLOTA FL 4
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1511
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Country | US
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Telephone | 714-644-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 2437 DUKE PL
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City | COSTA MESA
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State | CA
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Zip | 92626-6313
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Country | US
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Telephone | 949-600-0234
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 149489
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License Number State | CA
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