Provider Demographics
NPI:1609756519
Name:GLASS, ANDREA L (BS, MS)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:GLASS
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IN
Mailing Address - Zip Code:47140-8725
Mailing Address - Country:US
Mailing Address - Phone:317-771-4221
Mailing Address - Fax:
Practice Address - Street 1:1584 OLD HIGHWAY 135 NE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2002
Practice Address - Country:US
Practice Address - Phone:812-738-3277
Practice Address - Fax:812-738-4092
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005585A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health