Provider Demographics
NPI:1265985055
Name:ANDREA R GARY
Entity type:Organization
Organization Name:ANDREA R GARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-344-7279
Mailing Address - Street 1:1823 TOUCHET DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5649
Mailing Address - Country:US
Mailing Address - Phone:337-344-7279
Mailing Address - Fax:520-743-9373
Practice Address - Street 1:1823 TOUCHET DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5649
Practice Address - Country:US
Practice Address - Phone:337-344-7279
Practice Address - Fax:520-743-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid