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NPI Code Detail

MEDICARE: JON ALAN VAN FOSSAN

MEDICARE: JON ALAN VAN FOSSAN
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 TherapistMFC 43861CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106H00000XOTHERCAMFT

General Provider Information

NPI Number : 1811005432
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON ALAN VAN FOSSAN
Provider Business Mailing Address
First Line : 18389 UTILITY AVE
Second Line :
City : ANDERSON
State : CA
Zip : 96007-8423
Country : US
Telephone Number : 530-241-0337
Fax Number :
Provider Business Practice Location Address
First Line : 2640 BRESLAUER WAY
Second Line :
City : REDDING
State : CA
Zip : 96001-4246
Country : US
Telephone Number : 530-245-6416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 05/13/2024

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Directions to “ JON ALAN VAN FOSSAN ” Practice Location

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