Provider Demographics
NPI:1851777627
Name:REID, ANDREA FAYE
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:FAYE
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4920
Mailing Address - Country:US
Mailing Address - Phone:918-420-5006
Mailing Address - Fax:918-420-5087
Practice Address - Street 1:1100 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4920
Practice Address - Country:US
Practice Address - Phone:918-420-5006
Practice Address - Fax:918-420-5087
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor