Provider Demographics
NPI:1184263725
Name:DOSEN, ANDREA MARIE (LPCC, LCPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:DOSEN
Suffix:
Gender:F
Credentials:LPCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MULLAN RD APT D218
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5138
Mailing Address - Country:US
Mailing Address - Phone:502-919-2289
Mailing Address - Fax:
Practice Address - Street 1:540 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1154
Practice Address - Country:US
Practice Address - Phone:502-712-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-70008101YP2500X
KY261629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional