Provider Demographics
NPI:1407438179
Name:NEWMAN, ANDREW MARK (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S HIGLEY RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4789
Mailing Address - Country:US
Mailing Address - Phone:515-419-1702
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6688
Practice Address - Country:US
Practice Address - Phone:480-962-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty