Provider Demographics
NPI:1417247396
Name:PRICE, ANDREA NICHOLE (MS, LPC, CGDC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS, LPC, CGDC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC, CGDC
Mailing Address - Street 1:9233 WARD PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3360
Mailing Address - Country:US
Mailing Address - Phone:816-822-1922
Mailing Address - Fax:816-822-2248
Practice Address - Street 1:9233 WARD PKWY STE 360
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3360
Practice Address - Country:US
Practice Address - Phone:816-822-1922
Practice Address - Fax:816-822-2248
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2196101YP2500X
MO2009018435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO46079026OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER