Provider Demographics
NPI:1346821063
Name:WORTHING, ANDREW (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WORTHING
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 EARLE BROWN DR STE 420
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2562
Mailing Address - Country:US
Mailing Address - Phone:612-860-8175
Mailing Address - Fax:
Practice Address - Street 1:6040 EARLE BROWN DR STE 420
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2562
Practice Address - Country:US
Practice Address - Phone:612-860-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4001OtherMARRIAGE AND FAMILY THERAPY LICENSE