Provider Demographics
NPI:1457674707
Name:ANDRE, VILMAN (MA)
Entity Type:Individual
Prefix:
First Name:VILMAN
Middle Name:
Last Name:ANDRE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 S WHITBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4824
Mailing Address - Country:US
Mailing Address - Phone:405-227-2408
Mailing Address - Fax:
Practice Address - Street 1:3140 W BRITTON RD STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2039
Practice Address - Country:US
Practice Address - Phone:405-607-6292
Practice Address - Fax:405-607-6307
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist