Provider Demographics
NPI:1376976951
Name:FREDERICK, ANDREW SCOTT (MHR, LPC, CADC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:MHR, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 SE 67TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1739
Mailing Address - Country:US
Mailing Address - Phone:405-474-7098
Mailing Address - Fax:855-834-0431
Practice Address - Street 1:5933 SE 67TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1739
Practice Address - Country:US
Practice Address - Phone:405-474-7098
Practice Address - Fax:855-834-0431
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7566101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor