Provider Demographics
NPI:1659651669
Name:MUNDT, ANDREA M (BS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MUNDT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 E SKELLY DR
Mailing Address - Street 2:STE. 310
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6358
Mailing Address - Country:US
Mailing Address - Phone:918-599-7404
Mailing Address - Fax:
Practice Address - Street 1:3105 E SKELLY DR
Practice Address - Street 2:STE. 310
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6358
Practice Address - Country:US
Practice Address - Phone:918-599-7404
Practice Address - Fax:918-584-2530
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health