Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 5946-125 | WI |
NPI | 1003261132 |
---|---|
Provider Name | Danielle Vander Velden |
First Address | Pullman, WA 99163-3965 |
Second Address | Pullman, WA 99163-4120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 26/04/2016 |