Andrea L Stocker
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Tehachapi, CA
NPI 1609595362 · NPPES record last updated Oct 25, 2022
Key facts
- NPI
- 1609595362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- ANDREA L STOCKER
- Practice address
- 122 S Green St
Tehachapi, CA 93561-1717 - Phone
- (760) 428-2776
- NPI assigned
- Aug 25, 2022
- Organization subpart
- No
Authorized official
- Name
- Mrs. Andrea L Stocker, LCSW
- Title
- Sole Proprietor
- Phone
- (760) 428-2776
Practitioners 1
-
Andrea L Stocker, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221206002024 | CA | Part B Supplier - Clinic/Group Practice | 7517336084 |
Receives reassigned benefits from 1 practitioner Practice locations: Tehachapi, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
122 S Green St
Tehachapi, CA 93561-1717
Mailing address
PO Box 2390
Tehachapi, CA 93581-2390
Phone (760) 428-2776
Other names
- Seasons of Change Therapeutic Services
Other providers in Tehachapi, CA
- Malinda Leigh Alsop
- Jack Ray Alvord
- Mari F. Anaya
- Michelle Anderson
- Russell N Anderson
- Antelope Valley Lung Institute Medical Group
- Mary Anziano
- Charles David Arcaro
- Ciarra B Armstrong
- Michka Atarod
All providers in Tehachapi, CA · Mental Health Clinic/Center (Including Community Mental Health Center) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.