Individual provider Active NPI

Serena Jade Andrews, AMFT

  • Marriage & Family Therapist
  • San Luis Obispo, CA
National Provider Identifier
1669005609
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
117037 Issued in CA
Practice address
1461 Higuera St Ste C
San Luis Obispo, CA 93401-2948
Phone
(805) 242-6551
NPI assigned
Feb 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 117037 CA Primary

Addresses

Primary practice location

1461 Higuera St Ste C
San Luis Obispo, CA 93401-2948

Mailing address

793 E. Foothill Blvd
Ste a, PMB 189
San Luis Obispo, CA 93405
Phone (805) 538-8708

Other practice location 1

676 Pismo St
San Luis Obispo, CA 93401-3945
Phone (805) 543-7969

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
117037CAMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1669005609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 E. FOOTHILL BLVD",
            "address_2": "STE A, PMB 189",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93405",
            "telephone_number": "805-538-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 HIGUERA ST STE C",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012948",
            "telephone_number": "805-242-6551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 Pismo St",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934013945",
            "country_code": "US",
            "telephone_number": "805-543-7969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDREWS",
        "first_name": "SERENA",
        "middle_name": "JADE",
        "name_prefix": "Miss",
        "credential": "AMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "117037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.