Provider Demographics
NPI:1285106740
Name:SY, ANDRE (AMFT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:SY
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W IMPERIAL HWY APT 512
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7055
Mailing Address - Country:US
Mailing Address - Phone:714-928-9101
Mailing Address - Fax:
Practice Address - Street 1:30 COUNTRY WOOD DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4818
Practice Address - Country:US
Practice Address - Phone:909-623-3400
Practice Address - Fax:909-599-8223
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist