1003118209 NPI number — DAVID LORY VANDERBEEK M.S. LMFT

Table of content: DAVID LORY VANDERBEEK M.S. LMFT (NPI 1003118209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003118209 NPI number — DAVID LORY VANDERBEEK M.S. LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERBEEK
Provider First Name:
DAVID
Provider Middle Name:
LORY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003118209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAHRUMP
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89041-6264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-274-1571
Provider Business Mailing Address Fax Number:
775-751-8650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3370 S. HIGHWAY 160
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-274-1571
Provider Business Practice Location Address Fax Number:
775-751-8650
Provider Enumeration Date:
11/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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