Basic Information
| Provider Information | |||||||||
| NPI: | 1053591156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MOLLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2053 SUNNYBANK DR | ||||||||
| Address2: | |||||||||
| City: | LA CANADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910111356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182495990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1540 E COLORADO ST | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182447257 | ||||||||
| FaxNumber: | 8182435431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 47563 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.