Healthcare Provider Details

I. General information

NPI: 1073438396
Provider Name (Legal Business Name): ANDREW DEMICHELE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E OVILLA RD
RED OAK TX
75154-3834
US

IV. Provider business mailing address

208 BUFFALO CREEK DR
WAXAHACHIE TX
75165-1539
US

V. Phone/Fax

Practice location:
  • Phone: 972-268-3096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: