MEDICARE: MR. JOSEPH DANIEL VAN DORF MA, LPCC

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	101YP2500X	Professional Counselor	4571	MN

General Provider Information

NPI Number	:	1679309603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DANIEL VAN DORF MA, LPCC

Provider Business Mailing Address
First Line	:	2303 WYCLIFF ST STE 370
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1272
Country	:	US
Telephone Number	:	612-416-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 WYCLIFF ST STE 370
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1272
Country	:	US
Telephone Number	:	612-416-5595
Fax Number	:

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

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	12/03/2025

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