Provider Demographics
NPI:1639782147
Name:VANDENBURG, WESLEY BURDETTE (MA IN COUNSELING)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:BURDETTE
Last Name:VANDENBURG
Suffix:
Gender:M
Credentials:MA IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-9431
Mailing Address - Country:US
Mailing Address - Phone:616-558-7464
Mailing Address - Fax:
Practice Address - Street 1:885 BEECH ST
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-9431
Practice Address - Country:US
Practice Address - Phone:616-558-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor