Provider Demographics
NPI:1730213737
Name:PRESTON, ANDREW ALLEN (LMFT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ALLEN
Last Name:PRESTON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E. 1ST STREET #1205
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-6500
Mailing Address - Country:US
Mailing Address - Phone:310-435-3933
Mailing Address - Fax:
Practice Address - Street 1:100 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4417
Practice Address - Country:US
Practice Address - Phone:562-427-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69517106H00000X
CAIMF 50032225400000X
CA53409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANHF9087OtherMEDICAL SFPR RENDERING ID