MEDICARE: STEVEN MAX ANDRUS ACMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9060966-6009	UT
2	101YM0800X	Mental Health Counselor	9060966-6009	UT

General Provider Information

NPI Number	:	1215275003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MAX ANDRUS ACMHC

Provider Business Mailing Address
First Line	:	2337 E OLYMPUS VISTA CT
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2820
Country	:	US
Telephone Number	:	801-516-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 E GRAYSTONE WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2673
Country	:	US
Telephone Number	:	801-516-9054
Fax Number	:

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

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	05/20/2022

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