Provider Demographics
NPI:1285159210
Name:LUONG, ANDY (MFTI)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 WESTMINSTER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3370
Mailing Address - Country:US
Mailing Address - Phone:714-548-5226
Mailing Address - Fax:
Practice Address - Street 1:8251 WESTMINSTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3370
Practice Address - Country:US
Practice Address - Phone:714-839-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF72553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist