Provider Demographics
NPI:1518157882
Name:SHIELDS, ANDREA (PHD, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 S 700 E STE 180
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8320
Mailing Address - Country:US
Mailing Address - Phone:801-824-2862
Mailing Address - Fax:801-590-8717
Practice Address - Street 1:4516 S 700 E STE 180
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8320
Practice Address - Country:US
Practice Address - Phone:801-824-2862
Practice Address - Fax:801-590-8717
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist