Provider Demographics
NPI:1649869942
Name:MENHENNET, ANDREA E (LAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:MENHENNET
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13026 W MODESTO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5104
Mailing Address - Country:US
Mailing Address - Phone:520-425-1871
Mailing Address - Fax:
Practice Address - Street 1:6540 E KELTON LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1406
Practice Address - Country:US
Practice Address - Phone:480-998-0560
Practice Address - Fax:480-998-1058
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health