Provider Demographics
NPI:1649757725
Name:GARRISON, ANDREW (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-7607
Mailing Address - Country:US
Mailing Address - Phone:309-623-4459
Mailing Address - Fax:
Practice Address - Street 1:3333 155TH AVE
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-7607
Practice Address - Country:US
Practice Address - Phone:309-623-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional