Provider Demographics
NPI:1275132912
Name:TIERNAN, ANDREW WILLIAM (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:TIERNAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 DAVIS ST # 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4491
Mailing Address - Country:US
Mailing Address - Phone:107-677-3294
Mailing Address - Fax:
Practice Address - Street 1:622 DAVIS ST
Practice Address - Street 2:STE. 200
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4491
Practice Address - Country:US
Practice Address - Phone:773-294-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional