Provider Demographics
NPI:1437545092
Name:VAN DER VEEN, ERIN JO (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JO
Last Name:VAN DER VEEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 UPPER BEN LOMOND DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3752
Mailing Address - Country:US
Mailing Address - Phone:503-302-4239
Mailing Address - Fax:
Practice Address - Street 1:325 SUPERIOR ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5160
Practice Address - Country:US
Practice Address - Phone:503-990-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health