Provider Demographics
NPI:1457850976
Name:SCHMITZ, ANDREA LYNNE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNNE
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W CARLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6939
Mailing Address - Country:US
Mailing Address - Phone:480-465-7139
Mailing Address - Fax:
Practice Address - Street 1:333 N DOBSON RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:602-753-7379
Practice Address - Fax:888-979-6238
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10393101YM0800X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10393OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS LMFT
AZ533228Medicaid