| Thomas R Van Fossen | |
|
5431 N Government Way # B Coeur D Alene ID 83815-5073 | |
| (208) 667-7603 | |
| (208) 667-7609 |
| Full Name | Thomas R Van Fossen |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5431 N Government Way # B, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Thomas R Van Fossen (OWNER) |
| Authorized Official Contact | 2086677603 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas R Van Fossen 5431 N Government Way # B Coeur D Alene ID 83815-5073 Ph: (208) 667-7603 | Thomas R Van Fossen 5431 N Government Way # B Coeur D Alene ID 83815-5073 Ph: (208) 667-7603 |
| NPI Number | 1730496035 |
|---|---|
| Provider Enumeration Date | 09/08/2010 |
| Last Update Date | 11/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730496035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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