Individual
ANDREA LYSTRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFTI
Contact information
Practice address
911 N BUFFALO DR, SUITE 213, LAS VEGAS, NV 89128-0379
(702) 942-1774
Mailing address
911 N BUFFALO DR, SUITE 213, LAS VEGAS, NV 89128-0379
(702) 942-1774
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MI0654
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457600645
—
NV
Enumeration date
09/11/2015
Last updated
09/11/2015
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