Provider Demographics
NPI:1194955948
Name:ANDRIJESKI, CONCEPCION M (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:CONCEPCION
Middle Name:M
Last Name:ANDRIJESKI
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:MRS
Other - First Name:CONCHITA
Other - Middle Name:M
Other - Last Name:ANDRIJESKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S
Mailing Address - Street 1:602 STRADA CIR
Mailing Address - Street 2:112
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3201
Mailing Address - Country:US
Mailing Address - Phone:682-203-7096
Mailing Address - Fax:
Practice Address - Street 1:602 STRADA CIR
Practice Address - Street 2:SUITE 112
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3201
Practice Address - Country:US
Practice Address - Phone:682-203-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17140101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor