Provider Demographics
NPI:1770960015
Name:CLEMENS, ANDREW PHILIP
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILIP
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 146TH ST W STE 114
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3749
Mailing Address - Country:US
Mailing Address - Phone:952-443-4600
Mailing Address - Fax:651-322-4603
Practice Address - Street 1:2930 146TH ST W STE 114
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3749
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:651-322-4603
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist