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General NPI Number Information
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NPI Number | 1821121708
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Entity Type | Individual
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Provider Name | KIMBERLY NICOLE VAN VELZEN MFT
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2699 CHANNEL DR
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City | VENTURA
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State | CA
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Zip | 93003-4627
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Country | US
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Telephone | 818-644-2001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24153
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City | VENTURA
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State | CA
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Zip | 93002-4153
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Country | US
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Telephone | 818-644-2001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 45584
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 45584
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License Number State | CA
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