Provider Demographics
NPI:1417273376
Name:BROWN, ANDREA NICOLE (PSS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:NICOLE
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA, PSS
Mailing Address - Street 1:90398 MARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-8702
Mailing Address - Country:US
Mailing Address - Phone:541-653-5033
Mailing Address - Fax:
Practice Address - Street 1:90398 MARCOLA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-8702
Practice Address - Country:US
Practice Address - Phone:541-653-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health