Provider Demographics
NPI:1205392834
Name:DEASES, ANDREA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:DEASES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 DRUSE LN
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1723
Mailing Address - Country:US
Mailing Address - Phone:512-876-7118
Mailing Address - Fax:
Practice Address - Street 1:605 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-2406
Practice Address - Country:US
Practice Address - Phone:512-876-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health