Provider Demographics
NPI:1245590702
Name:REICHERT, ANDREW DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:REICHERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N GARLAND AVE
Mailing Address - Street 2:# 2700
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-4030
Mailing Address - Country:US
Mailing Address - Phone:979-575-4971
Mailing Address - Fax:
Practice Address - Street 1:3214 NW AVIGNON WAY
Practice Address - Street 2:# 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3916
Practice Address - Country:US
Practice Address - Phone:979-575-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-26P103TC1900X
TX35148103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling