Provider Demographics
NPI:1013302504
Name:KOUTRAS, ANDREA (LLMSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KOUTRAS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-746-7500
Mailing Address - Fax:989-746-4658
Practice Address - Street 1:3201 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2109
Practice Address - Country:US
Practice Address - Phone:989-746-7500
Practice Address - Fax:989-746-4658
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL6970181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical