Healthcare Provider Details

I. General information

NPI: 1518049238
Provider Name (Legal Business Name): ANDREA LYN TODD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 ARBOR STATION DR
LONG BEACH MS
39560-5741
US

IV. Provider business mailing address

5201 LAKELAND BLVD APT F56
FLOWOOD MS
39232-8914
US

V. Phone/Fax

Practice location:
  • Phone: 228-731-3988
  • Fax: 321-256-7325
Mailing address:
  • Phone: 228-731-2722
  • Fax: 321-256-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06-20P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number06-20P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: