Provider Demographics
NPI:1043335003
Name:ANDREWS, MAURINE JENNIFER (LPC)
Entity type:Individual
Prefix:MRS
First Name:MAURINE
Middle Name:JENNIFER
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 ARCTURUS AVE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2907
Mailing Address - Country:US
Mailing Address - Phone:505-730-7518
Mailing Address - Fax:
Practice Address - Street 1:705 ARCTURUS AVE SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2907
Practice Address - Country:US
Practice Address - Phone:505-730-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0098601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional