Provider Demographics
NPI:1477160216
Name:ANDREWS, JASON (LPCC, LCADC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-1504
Mailing Address - Country:US
Mailing Address - Phone:270-415-5155
Mailing Address - Fax:
Practice Address - Street 1:417 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-1504
Practice Address - Country:US
Practice Address - Phone:270-415-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272326101YA0400X
KY282914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)