Healthcare Provider Details

I. General information

NPI: 1558118315
Provider Name (Legal Business Name): ANDREA B CORTES SIERRA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16941 N EAGLE RIVER LOOP RD STE 4
EAGLE RIVER AK
99577-7824
US

IV. Provider business mailing address

1631 KENT DR
WEBB CITY MO
64870-9644
US

V. Phone/Fax

Practice location:
  • Phone: 907-406-7707
  • Fax:
Mailing address:
  • Phone: 417-629-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2481501
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90388
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026006071
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number250720
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: