Provider Demographics
NPI:1609122696
Name:VAN ECK, STEPHANIE NEZ
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NEZ
Last Name:VAN ECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEVIE
Other - Middle Name:NEZ
Other - Last Name:VAN ECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:260 COHASSET RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2282
Mailing Address - Country:US
Mailing Address - Phone:530-894-5933
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:260 COHASSET RD STE 120
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2282
Practice Address - Country:US
Practice Address - Phone:530-894-5933
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 649121041C0700X, 1041C0700X
CA1018921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical