Provider Demographics
NPI:1770099772
Name:VANFOSSEN, LYNN A (LPC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:VANFOSSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2526
Mailing Address - Country:US
Mailing Address - Phone:304-865-5444
Mailing Address - Fax:304-865-5445
Practice Address - Street 1:911 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-2526
Practice Address - Country:US
Practice Address - Phone:304-865-5444
Practice Address - Fax:304-865-5444
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health