Healthcare Provider Details

I. General information

NPI: 1376978445
Provider Name (Legal Business Name): ANDREA MARIE LIEBHART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 84
CARROLLTON MO
64633-0084
US

IV. Provider business mailing address

PO BOX 84
CARROLLTON MO
64633-0084
US

V. Phone/Fax

Practice location:
  • Phone: 660-631-8752
  • Fax:
Mailing address:
  • Phone: 660-631-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7783
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22756
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923280
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020022757
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4490
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: