MEDICARE: DOUGLAS GENE VANDERLAAN MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401009642	MI

General Provider Information

NPI Number	:	1538180377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS GENE VANDERLAAN MA, LPC

Provider Business Mailing Address
First Line	:	1608 GREEN AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5509
Country	:	US
Telephone Number	:	989-450-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 WASHINGTON AVE
Second Line	:	SUITE 400
City	:	BAY CITY
State	:	MI
Zip	:	48708-5729
Country	:	US
Telephone Number	:	989-450-1904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/17/2013

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