Provider Demographics
NPI:1962721852
Name:MCCAUSE, ANDREA JO (BA MENTAL HEALTH)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JO
Last Name:MCCAUSE
Suffix:
Gender:F
Credentials:BA MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-8911
Mailing Address - Country:US
Mailing Address - Phone:918-316-0628
Mailing Address - Fax:918-681-1116
Practice Address - Street 1:502 E CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5535
Practice Address - Country:US
Practice Address - Phone:918-681-1113
Practice Address - Fax:918-681-1116
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health