MEDICARE: MS. ANDREA LYNNE TEMPLETON AMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	70852	CA
2	106H00000X	Marriage & Family Therapist	106948	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106948	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1053672774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LYNNE TEMPLETON AMFT

Provider Business Mailing Address
First Line	:	1690 W SHAW AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3519
Country	:	US
Telephone Number	:	559-436-0482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 W SHAW AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3519
Country	:	US
Telephone Number	:	559-436-0482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	08/27/2021

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