Healthcare Provider Details

I. General information

NPI: 1235397951
Provider Name (Legal Business Name): ROBIN ELAINE VAN CLEAVE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN ELAINE VAN HERRMANN

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E MAIN ST STE 210
GRASS VALLEY CA
95945-6542
US

IV. Provider business mailing address

PO BOX 475
GRASS VALLEY CA
95945-0475
US

V. Phone/Fax

Practice location:
  • Phone: 530-902-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: