Provider Demographics
NPI:1841576816
Name:ANDREAS, ELISSA (LAC, CBP)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:
Last Name:ANDREAS
Suffix:
Gender:F
Credentials:LAC, CBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 TUMBLED STONE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5372
Mailing Address - Country:US
Mailing Address - Phone:931-237-6865
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR
Practice Address - Street 2:SUITE 4
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1331
Practice Address - Country:US
Practice Address - Phone:254-392-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist