Provider Demographics
NPI:1124697438
Name:CHANG, ANDREW (MFT-TRAINEE)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MFT-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 LA MIRADA AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2238
Mailing Address - Country:US
Mailing Address - Phone:310-736-8562
Mailing Address - Fax:
Practice Address - Street 1:15350 SHERMAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4458
Practice Address - Country:US
Practice Address - Phone:818-267-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician