Provider Demographics
NPI:1598062663
Name:ECHANIS, ANDREW (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ECHANIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-1022
Mailing Address - Country:US
Mailing Address - Phone:208-452-7705
Mailing Address - Fax:208-452-7750
Practice Address - Street 1:131 N WHITLEY DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2430
Practice Address - Country:US
Practice Address - Phone:208-452-7705
Practice Address - Fax:208-452-7750
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker