Provider Demographics
NPI:1275954505
Name:MCGRATH, ANDREA MOLLY (MA LPC LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MOLLY
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MA LPC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2304
Mailing Address - Country:US
Mailing Address - Phone:402-469-2699
Mailing Address - Fax:
Practice Address - Street 1:1575 N 4TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-721-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11578101YP2500X
WY1661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional