Doctor Name: | MR. KERRY VAN VOLKINBURGH |
NPI Number: | 1265862452 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA,LPC |
License Number: | LPC-14034 |
Business Practice Address: | 291 W. Casa Blanca Rd Sacaton, AZ - 851470001 |
Business Phone Number: | 5205623321 |
Business Fax Number: | |
Mailing Address: | Po Box 38, SACATON |
State: | AZ |
Postal Code: | 851470001 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/25/2013 |
NPI Last Update Date: | 11/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-14034 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |