Provider Demographics
NPI:1477626000
Name:HENDEL, ANDREA MICHELLE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:HENDEL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 90TH ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7465
Mailing Address - Country:US
Mailing Address - Phone:763-777-9499
Mailing Address - Fax:763-373-9463
Practice Address - Street 1:16201 90TH ST NE STE 203
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7465
Practice Address - Country:US
Practice Address - Phone:763-777-9499
Practice Address - Fax:763-373-9463
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN310470200Medicaid