Provider Demographics
NPI:1740271261
Name:VANESSEN, VIVIAN ANNETT (LPC)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:ANNETT
Last Name:VANESSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:VIVIAN
Other - Middle Name:ANNETT
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1028 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2910
Mailing Address - Country:US
Mailing Address - Phone:605-665-4606
Mailing Address - Fax:605-665-4673
Practice Address - Street 1:1028 WALNUT ST
Practice Address - Street 2:LEWIS & CLARK BHS
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2910
Practice Address - Country:US
Practice Address - Phone:605-665-4606
Practice Address - Fax:605-665-4673
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC643101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor