MEDICARE: OLIVIA ANDREW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346177565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVIA ANDREW

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-0056
Country	:	US
Telephone Number	:	330-360-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E MAIN ST STE A
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3174
Country	:	US
Telephone Number	:	330-360-0543
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVIA ANDREW
Credential	:
Telephone Number	:	330-360-0543

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/08/2026

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