Provider Demographics
NPI:1417401043
Name:GARY, ANDREA R (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:GARY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 TOUCHET DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5649
Mailing Address - Country:US
Mailing Address - Phone:337-344-7279
Mailing Address - Fax:520-743-9373
Practice Address - Street 1:1823 TOUCHET DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5649
Practice Address - Country:US
Practice Address - Phone:337-344-7279
Practice Address - Fax:520-743-9373
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid
LAPENDINGMedicare UPIN