Provider Demographics
NPI:1871735761
Name:DARCHUK, ANDREW J (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:DARCHUK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SHEPPARD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2527
Mailing Address - Country:US
Mailing Address - Phone:507-985-2155
Mailing Address - Fax:
Practice Address - Street 1:2100 SHEPPARD DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2527
Practice Address - Country:US
Practice Address - Phone:507-985-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4995103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical