Provider Demographics
NPI:1801149745
Name:VANDER VEER, MARY ANN (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:VANDER VEER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 W CHARLESTON BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1570
Mailing Address - Country:US
Mailing Address - Phone:702-980-5241
Mailing Address - Fax:702-975-8232
Practice Address - Street 1:7331 W CHARLESTON BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1570
Practice Address - Country:US
Practice Address - Phone:360-957-5898
Practice Address - Fax:702-489-7844
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60454153101YM0800X
WACG60113142101YM0800X
NVCP2907R101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054842Medicaid
NV1801149745Medicaid