Individual ProviderAndrea LystrupCounselorBehavioral Health & Social Service ProvidersPractice Address911 N Buffalo Dr, Suite 213, Las Vegas, NV 89128-0379(702) 942-1774PECOS EnrollmentBased on the most recent information from CMS, provider Andrea Lystrup does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1255709994Provider TypeIndividualFull NameLystrup, AndreaCredentialMFTIGenderFemaleSole ProprietorYesEnumeration Date9/11/2015Last Updated9/11/2015Contact InformationPractice LocationPractice Address911 N Buffalo Dr, Suite 213, Las Vegas, NV 89128-0379Phone(702) 942-1774FaxUnlisted FaxMailing LocationMailing Address911 N Buffalo Dr, Suite 213, Las Vegas, NV 89128-0379Phone(702) 942-1774FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMI0654NevadaProvider IdentifiersIDDescriptionIssuerID1457600645DescriptionMedicaidIssuerUnlistedNevada