Provider Demographics
NPI:1518049238
Name:TODD, ANDREA LYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYN
Last Name:TODD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 LAKELAND BLVD APT F56
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8914
Mailing Address - Country:US
Mailing Address - Phone:228-731-2722
Mailing Address - Fax:321-256-7325
Practice Address - Street 1:542 ARBOR STATION DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-5741
Practice Address - Country:US
Practice Address - Phone:228-731-3988
Practice Address - Fax:321-256-7325
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-20P103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist