Provider Demographics
NPI:1487129748
Name:ANDREW, KATHRYN LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:ANDREW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FIR ST STE 208
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2661
Mailing Address - Country:US
Mailing Address - Phone:541-809-8045
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:105 FIR ST STE 208
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2661
Practice Address - Country:US
Practice Address - Phone:541-809-8045
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL55162101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health