MEDICARE: MS. KELLY L ANDREWS MS, LPC, RPT

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	251S00000X	Community/Behavioral Health Agency	0701004935	VA
2	101YP2500X	Professional Counselor	0701004935	VA

General Provider Information

NPI Number	:	1528367216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY L ANDREWS MS, LPC, RPT

Provider Business Mailing Address
First Line	:	2106 THOROUGHGOOD RD
Second Line	:	MILITARY INTEGRATIVE THERAPIES, LLC
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4015
Country	:	US
Telephone Number	:	757-995-2196
Fax Number	:	757-995-2197

Provider Business Practice Location Address
First Line	:	2106 THOROUGHGOOD RD
Second Line	:	MILITARY INTEGRATIVE THERAPIES, LLC
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4015
Country	:	US
Telephone Number	:	757-995-2196
Fax Number	:	757-995-2197

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	06/21/2016

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