Provider Demographics
NPI:1538238175
Name:ANDREWS, JERRY (LMFT, LISAC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:LMFT, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:400
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:602-938-3323
Mailing Address - Fax:602-938-1626
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:400
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:602-938-3323
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10178106H00000X
AZLISAC-10135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC-10135OtherTHERAPIST
AZLMFT-10178OtherTHERAPIST