Provider Demographics
NPI:1467660332
Name:VANMOUWERIK, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:VANMOUWERIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:VM
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 W OJAI AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2406
Mailing Address - Country:US
Mailing Address - Phone:805-646-7900
Mailing Address - Fax:
Practice Address - Street 1:402 W OJAI AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2406
Practice Address - Country:US
Practice Address - Phone:805-646-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11890103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling