Healthcare Provider Details

I. General information

NPI: 1770099772
Provider Name (Legal Business Name): LYNN A VANFOSSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 EMERSON AVE
PARKERSBURG WV
26104-2526
US

IV. Provider business mailing address

911 EMERSON AVE
PARKERSBURG WV
26104-2526
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-5444
  • Fax: 304-865-5444
Mailing address:
  • Phone: 304-865-5444
  • Fax: 304-865-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1400
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: