Provider Demographics
NPI:1386717700
Name:ANDROS, DAVID LOREN (MS, LP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LOREN
Last Name:ANDROS
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1442
Mailing Address - Country:US
Mailing Address - Phone:507-934-4160
Mailing Address - Fax:507-934-4160
Practice Address - Street 1:1120 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-3507
Practice Address - Country:US
Practice Address - Phone:507-934-4160
Practice Address - Fax:507-934-4160
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3107103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN525225-300OtherMNCARE PROVIDER NUMBER