Provider Demographics
NPI:1659994580
Name:ANDREWS, MARLA (LPC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CLINIC ROAD
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-4824
Mailing Address - Country:US
Mailing Address - Phone:208-879-4351
Mailing Address - Fax:
Practice Address - Street 1:611 CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226-4824
Practice Address - Country:US
Practice Address - Phone:208-879-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty