Provider Demographics
NPI:1023481058
Name:PUGH, ANDREA MARKEISHA (MS, LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARKEISHA
Last Name:PUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3400
Mailing Address - Country:US
Mailing Address - Phone:318-918-8816
Mailing Address - Fax:318-227-6179
Practice Address - Street 1:856 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-918-8816
Practice Address - Fax:318-227-6179
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14744101YM0800X
101YP2500X
TX85622101YM0800X
ORC7396101YM0800X
LA6372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional