Provider Demographics
NPI:1891307211
Name:YAVERSKI, ANDREA (LPCC0017477)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:YAVERSKI
Suffix:
Gender:F
Credentials:LPCC0017477
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5620 FOSSIL CREEK PKWY UNIT 9106
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7146
Mailing Address - Country:US
Mailing Address - Phone:970-620-7477
Mailing Address - Fax:
Practice Address - Street 1:323 W DRAKE RD STE 124
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8123
Practice Address - Country:US
Practice Address - Phone:970-620-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health