Provider Demographics
NPI:1548352164
Name:ANDRUS, MARGENE (LPC, CDCII, CDCS)
Entity type:Individual
Prefix:MS
First Name:MARGENE
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:LPC, CDCII, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:763-315-4669
Practice Address - Street 1:659 BIELENBERG DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1706
Practice Address - Country:US
Practice Address - Phone:651-259-9700
Practice Address - Fax:651-259-9780
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3477101YA0400X
AK476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0156Medicaid
AKMH0156Medicaid