Provider Demographics
NPI:1083420210
Name:GEREN, ANDREW (MFT-INTERN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GEREN
Suffix:
Gender:M
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 SUN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4232
Mailing Address - Country:US
Mailing Address - Phone:318-610-0750
Mailing Address - Fax:
Practice Address - Street 1:820 JORDAN ST STE 570
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4512
Practice Address - Country:US
Practice Address - Phone:318-610-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health