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NPI Code Detail

MEDICARE: CRAIG THOMAS VAN DYKE LMFT

MEDICARE: CRAIG THOMAS VAN DYKE LMFT
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
1106H00000XMarriage & Family Therapist108739CA

General Provider Information

NPI Number : 1609155316
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG THOMAS VAN DYKE LMFT
Provider Business Mailing Address
First Line : 3480 BUSKIRK AVE
Second Line : # 210
City : PLEASANT HILL
State : CA
Zip : 94523-4341
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1430 WILLOW PASS RD STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-7946
Country : US
Telephone Number : 925-288-3900
Fax Number : 925-646-5774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2011
Last Update Date : 01/08/2021

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