Provider Demographics
NPI:1407179666
Name:DERMYER, ANDREA JETT (LCMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JETT
Last Name:DERMYER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST
Mailing Address - Street 2:304
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1868
Mailing Address - Country:US
Mailing Address - Phone:913-345-9333
Mailing Address - Fax:913-345-9335
Practice Address - Street 1:8575 W 110TH ST
Practice Address - Street 2:304
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1868
Practice Address - Country:US
Practice Address - Phone:913-345-9333
Practice Address - Fax:913-345-9335
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist