Provider Demographics
NPI:1366770653
Name:HACHIYA, ANDREW JOHN (PSYD, LP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:HACHIYA
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 GOLDEN VALLEY RD
Mailing Address - Street 2:#100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4463
Mailing Address - Country:US
Mailing Address - Phone:763-225-4053
Mailing Address - Fax:763-225-4081
Practice Address - Street 1:5905 GOLDEN VALLEY RD
Practice Address - Street 2:#100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4463
Practice Address - Country:US
Practice Address - Phone:763-225-4053
Practice Address - Fax:763-225-4081
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5674103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist