Provider Demographics
NPI:1114332723
Name:ACOSTA, ANDREW JOHN (MA, MFT INTERN)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MA, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 EPSON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7247
Mailing Address - Country:US
Mailing Address - Phone:714-875-4822
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3195
Practice Address - Country:US
Practice Address - Phone:702-778-5300
Practice Address - Fax:702-778-5301
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist