Provider Demographics
NPI:1053682732
Name:VAN DEUSEN, MOLLIE M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:M
Last Name:VAN DEUSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 E HYW 377
Mailing Address - Street 2:SUITE 116
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049
Mailing Address - Country:US
Mailing Address - Phone:940-902-2632
Mailing Address - Fax:
Practice Address - Street 1:4425 E HYW 377
Practice Address - Street 2:SUITE 116
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049
Practice Address - Country:US
Practice Address - Phone:940-902-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional