Provider Demographics
NPI:1285057802
Name:ANDY STUCK PH.D LISW LLC
Entity type:Organization
Organization Name:ANDY STUCK PH.D LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:STUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-785-1223
Mailing Address - Street 1:870 HIGH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4139
Mailing Address - Country:US
Mailing Address - Phone:614-785-1223
Mailing Address - Fax:614-785-1323
Practice Address - Street 1:870 HIGH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4139
Practice Address - Country:US
Practice Address - Phone:614-785-1223
Practice Address - Fax:614-785-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLISW-S 0074741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty