Provider Demographics
NPI:1689938557
Name:ANDRES, ALICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 PLATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1942
Mailing Address - Country:US
Mailing Address - Phone:573-516-5666
Mailing Address - Fax:
Practice Address - Street 1:7023 PLATEAU AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1942
Practice Address - Country:US
Practice Address - Phone:719-377-1235
Practice Address - Fax:719-377-1235
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009703103TC0700X
COPSY.0004536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical