Provider Demographics
NPI:1073975389
Name:GERODIAS, ANDREW (LMHC TEMP, CADC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GERODIAS
Suffix:
Gender:M
Credentials:LMHC TEMP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3200
Mailing Address - Country:US
Mailing Address - Phone:712-202-0777
Mailing Address - Fax:712-202-0780
Practice Address - Street 1:3320 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3200
Practice Address - Country:US
Practice Address - Phone:712-202-0777
Practice Address - Fax:712-202-0780
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14020101YA0400X
IA079514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)