Provider Demographics
NPI:1437213048
Name:LAUE, ANDREW RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RICHARD
Last Name:LAUE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 STOCKYARD RD STE F4
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1508
Mailing Address - Country:US
Mailing Address - Phone:406-327-9445
Mailing Address - Fax:406-541-5532
Practice Address - Street 1:2825 STOCKYARD RD STE F4
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1508
Practice Address - Country:US
Practice Address - Phone:406-327-9445
Practice Address - Fax:406-541-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCSW 3701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT71051OtherBLUE CROSS BLUE SHIELD
MT0500412Medicaid
MT00050010Medicare ID - Type Unspecified