Provider Demographics
NPI:1740966050
Name:FORTNEY, ANDREW FREDERICK (MA, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:FREDERICK
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:MA, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3739
Mailing Address - Country:US
Mailing Address - Phone:214-744-3366
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY STE 613
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5326
Practice Address - Country:US
Practice Address - Phone:214-530-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty