Provider Demographics
NPI:1003082504
Name:VANDIXHORN, JOHN CARL (PH D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:VANDIXHORN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 N WINNERS CIR APT B
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5867
Mailing Address - Country:US
Mailing Address - Phone:760-320-6648
Mailing Address - Fax:760-770-5652
Practice Address - Street 1:225 S CIVIC DR
Practice Address - Street 2:SUITE 217
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7226
Practice Address - Country:US
Practice Address - Phone:760-320-6648
Practice Address - Fax:760-770-5652
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist