Basic Information
| Provider Information | |||||||||
| NPI: | 1063928489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MED, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16782 VON KARMAN AVE STE 11 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926062417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552237123 | ||||||||
| FaxNumber: | 6193747134 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 W 40TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787563609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552237123 | ||||||||
| FaxNumber: | 6193747134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2017 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-52259 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.