Provider Demographics
NPI:1215534037
Name:VANDERVLUGT, JONATHAN ROYCE (LMHCA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROYCE
Last Name:VANDERVLUGT
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 GRANADA CT APT 111
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2161
Mailing Address - Country:US
Mailing Address - Phone:773-732-1155
Mailing Address - Fax:
Practice Address - Street 1:9614 GRANADA CT APT 111
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2161
Practice Address - Country:US
Practice Address - Phone:773-732-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty