MEDICARE: LISA ANDREWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2055X	Child Mental Illness Respite Care	6020052	AZ

General Provider Information

NPI Number	:	1205281268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANDREWS

Provider Business Mailing Address
First Line	:	2320 W PEORIA AVE
Second Line	:	SUITE B147
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4753
Country	:	US
Telephone Number	:	602-283-7117
Fax Number	:	602-896-2580

Provider Business Practice Location Address
First Line	:	11742 W CARIBBEAN LN
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-6984
Country	:	US
Telephone Number	:	623-842-6070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/27/2016

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Directions to “ LISA ANDREWS ” Practice Location

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