Provider Demographics
NPI:1639067200
Name:ENGAVO, ANDREA LYNN (CAP-212)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:ENGAVO
Suffix:
Gender:F
Credentials:CAP-212
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 PEAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4006
Mailing Address - Country:US
Mailing Address - Phone:307-349-8295
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 190
Practice Address - Street 2:
Practice Address - City:ST STEPHENS
Practice Address - State:WY
Practice Address - Zip Code:82524-0190
Practice Address - Country:US
Practice Address - Phone:307-856-8090
Practice Address - Fax:307-463-4254
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health