Healthcare Provider Details

I. General information

NPI: 1689193351
Provider Name (Legal Business Name): ANDREW HOLMGREN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 CANAL ST STE 203
NEW ORLEANS LA
70119-5878
US

IV. Provider business mailing address

4919 CANAL ST STE 203
NEW ORLEANS LA
70119-5878
US

V. Phone/Fax

Practice location:
  • Phone: 504-483-9883
  • Fax:
Mailing address:
  • Phone: 504-483-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC7157
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC7157
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: