Provider Demographics
NPI:1992073951
Name:UCKERT, ANDREA (LPC-MH, QMHP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:UCKERT
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1454
Mailing Address - Country:US
Mailing Address - Phone:605-592-5300
Mailing Address - Fax:605-696-7977
Practice Address - Street 1:619 5TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006
Practice Address - Country:US
Practice Address - Phone:605-592-5300
Practice Address - Fax:605-696-7977
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health