Provider Demographics
NPI:1346626223
Name:ANDREAE, TIMOTHY (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ANDREAE
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4428
Mailing Address - Country:US
Mailing Address - Phone:208-805-0105
Mailing Address - Fax:
Practice Address - Street 1:1674 W HILL RD STE 14
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0958
Practice Address - Country:US
Practice Address - Phone:208-805-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional