Provider Demographics
NPI:1740665686
Name:VANGORDER, ANDREA (NCC, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:VANGORDER
Suffix:
Gender:F
Credentials:NCC, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3154
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-3154
Mailing Address - Country:US
Mailing Address - Phone:405-586-3726
Mailing Address - Fax:
Practice Address - Street 1:910 SW E AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4593
Practice Address - Country:US
Practice Address - Phone:405-586-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1295106H00000X
OK6411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist