Provider Demographics
NPI:1790138493
Name:VANDERCOY, ANDY JAMES (TLMHC)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:JAMES
Last Name:VANDERCOY
Suffix:
Gender:M
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 ELMORE AVE APT H15
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3583
Mailing Address - Country:US
Mailing Address - Phone:309-738-8826
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-355-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health