Provider Demographics
NPI:1588172209
Name:ANDREA MCCRARY, PSYCHOTHERAPIST, LMHC, INC.
Entity type:Organization
Organization Name:ANDREA MCCRARY, PSYCHOTHERAPIST, LMHC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-348-7448
Mailing Address - Street 1:203A FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4916
Mailing Address - Country:US
Mailing Address - Phone:850-348-7448
Mailing Address - Fax:888-503-5896
Practice Address - Street 1:203A FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-348-7448
Practice Address - Fax:888-503-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016654600Medicaid