Provider Demographics
NPI:1003118209
Name:VANDERBEEK, DAVID LORY (MS LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LORY
Last Name:VANDERBEEK
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6264
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-6264
Mailing Address - Country:US
Mailing Address - Phone:702-274-1571
Mailing Address - Fax:775-751-8650
Practice Address - Street 1:3370 S. HIGHWAY 160
Practice Address - Street 2:SUITE 12
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:702-274-1571
Practice Address - Fax:775-751-8650
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health