Provider Demographics
NPI:1053606129
Name:ANDRESS, WENONA YVONNA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENONA
Middle Name:YVONNA
Last Name:ANDRESS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6502 SLIDE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1329
Mailing Address - Country:US
Mailing Address - Phone:806-771-8808
Mailing Address - Fax:806-771-8809
Practice Address - Street 1:3403 73RD ST
Practice Address - Street 2:STE 7
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1101
Practice Address - Country:US
Practice Address - Phone:806-474-5787
Practice Address - Fax:806-500-2936
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX416451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1041C0700XMedicaid