Provider Demographics
NPI:1467908012
Name:ANDREW OTT, LLC
Entity Type:Organization
Organization Name:ANDREW OTT, LLC
Other - Org Name:ANDREW OTT
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:J ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:260-387-6340
Mailing Address - Street 1:402 N. WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725
Mailing Address - Country:US
Mailing Address - Phone:260-244-7413
Mailing Address - Fax:260-387-6984
Practice Address - Street 1:402 N. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725
Practice Address - Country:US
Practice Address - Phone:260-244-7413
Practice Address - Fax:260-387-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005694A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health