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MR. THAN DEMETRISUS ANDROS AT

>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1235450172

Individual Registrant:
MR. THAN DEMETRISUS ANDROS AT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
417 W MAIN ST STE B TRUMANN, AR 72472-3116 US
Tel: 870-483-7039  Fax: 870-483-0590

Contact information for business:
5537 BLEAUX AVE  SPRINGDALE, AR 72762-0737 US
Tel: 479-872-5580  Fax: 479-872-5581

Registration Information:
NPI: 1235450172
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers
Counselor

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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