Provider Demographics
NPI:1831496439
Name:VANDER VEEN, JOSHUA TRENT (LMFT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TRENT
Last Name:VANDER VEEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34455 YUCAIPA BLVD # 205206
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2475
Mailing Address - Country:US
Mailing Address - Phone:909-790-3900
Mailing Address - Fax:909-768-1006
Practice Address - Street 1:34455 YUCAIPA BLVD # 205206
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2475
Practice Address - Country:US
Practice Address - Phone:909-790-3900
Practice Address - Fax:909-768-1006
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1488106H00000X
CA61621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist