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General NPI Number Information
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NPI Number | 1750929030
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Entity Type | Individual
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Provider Name | ANDREW JOHN SOUTHERLAND LPC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1802 HANKS ST
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City | LUFKIN
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State | TX
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Zip | 75904-5414
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Country | US
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Telephone | 307-550-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 S JOHN REDDITT DR SUITE E BOX 142
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City | LUFKIN
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State | TX
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Zip | 75904
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Country | US
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Telephone | 307-222-9243
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PPC-1109
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017183
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-2015
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 88702
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License Number State | TX
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