Provider Demographics
NPI:1508488651
Name:MIDDAGH, ANDREA LENORE
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LENORE
Last Name:MIDDAGH
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 1:132 INGLEWOOD
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-4845
Mailing Address - Country:US
Mailing Address - Phone:361-658-0608
Mailing Address - Fax:
Practice Address - Street 1:132 INGLEWOOD
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4845
Practice Address - Country:US
Practice Address - Phone:361-658-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health