Provider Demographics
NPI:1811346059
Name:ANDREASEN, MARIAH (LMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:
Last Name:ANDREASEN
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 104TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7942
Mailing Address - Country:US
Mailing Address - Phone:319-499-8107
Mailing Address - Fax:
Practice Address - Street 1:3209 INGERSOLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3920
Practice Address - Country:US
Practice Address - Phone:319-499-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health