Provider Demographics
NPI:1134147374
Name:ANDRUS, ROBERT MICHAL (GSW,LAC,BCCGC,CCS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAL
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:GSW,LAC,BCCGC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4425
Mailing Address - Country:US
Mailing Address - Phone:337-788-7515
Mailing Address - Fax:337-788-7626
Practice Address - Street 1:121 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4425
Practice Address - Country:US
Practice Address - Phone:337-788-7515
Practice Address - Fax:337-788-7626
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23101Y00000X
LA3101Y00000X
LA478101YA0400X
LA61111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical