Provider Demographics
NPI:1043996895
Name:VAN DRIMMELEN, LEXUS ANN
Entity Type:Individual
Prefix:
First Name:LEXUS
Middle Name:ANN
Last Name:VAN DRIMMELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HARROP ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4555
Mailing Address - Country:US
Mailing Address - Phone:801-935-5513
Mailing Address - Fax:
Practice Address - Street 1:1186 E 4600 S STE 200
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5097
Practice Address - Country:US
Practice Address - Phone:801-896-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health