Provider Demographics
NPI:1801460985
Name:SUTHERLAND, ANDREW C (AMFT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:SUTHERLAND
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 1:310 1/2 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6036
Mailing Address - Country:US
Mailing Address - Phone:092-417-9262
Mailing Address - Fax:
Practice Address - Street 1:310 1/2 1ST ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6036
Practice Address - Country:US
Practice Address - Phone:209-417-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136782372600000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA372600000XMedicaid