Provider Demographics
NPI:1467964031
Name:ANDROS FAMILY SERVICES
Entity Type:Organization
Organization Name:ANDROS FAMILY SERVICES
Other - Org Name:FREEDOM COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:ANDROS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LP
Authorized Official - Phone:507-934-4160
Mailing Address - Street 1:326 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1442
Mailing Address - Country:US
Mailing Address - Phone:507-934-4160
Mailing Address - Fax:
Practice Address - Street 1:1120 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-3507
Practice Address - Country:US
Practice Address - Phone:507-934-4160
Practice Address - Fax:507-934-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3107103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty