Healthcare Provider Details

I. General information

NPI: 1366026163
Provider Name (Legal Business Name): ANDREA ELIZABETH DEURING LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 11/03/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W
SAINT PAUL MN
55114-1052
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-6200
  • Fax: 952-977-1802
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2836
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: