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General NPI Number Information
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NPI Number | 1053606129
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Entity Type | Individual
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Provider Name | WENONA YVONNA ANDRESS LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 3403 73RD ST STE 7
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City | LUBBOCK
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State | TX
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Zip | 79423-1101
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Country | US
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Telephone | 806-474-5787
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Fax | 806-500-2936
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Provider Business Mailing Address
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Address Line | 6502 SLIDE RD SUITE 207
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City | LUBBOCK
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State | TX
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Zip | 79424-1329
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Country | US
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Telephone | 806-771-8808
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Fax | 806-771-8809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 41645
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License Number State | TX
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