Provider Demographics
NPI:1750767752
Name:PRZEKORA, ANDRAYA LYNN
Entity type:Individual
Prefix:MISS
First Name:ANDRAYA
Middle Name:LYNN
Last Name:PRZEKORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17719 BARRY ST
Mailing Address - Street 2:
Mailing Address - City:CHARTER TOWNSHIP OF CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-482-6077
Mailing Address - Fax:
Practice Address - Street 1:17719 BARRY ST
Practice Address - Street 2:
Practice Address - City:CHARTER TOWNSHIP OF CLINTON
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-482-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional