Provider Demographics
NPI:1508390634
Name:VAN DER VIEREN, DAVID (LPCI)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VAN DER VIEREN
Suffix:
Gender:M
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CARROLLTON
Mailing Address - State:TEXAS
Mailing Address - Zip Code:75010
Mailing Address - Country:UM
Mailing Address - Phone:952-457-7086
Mailing Address - Fax:
Practice Address - Street 1:4221 MEDICAL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4541
Practice Address - Country:US
Practice Address - Phone:952-457-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75615101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor