MEDICARE: JAN MICHELE VAN CHOFF LCSW

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	1041C0700X	Clinical Social Worker	13093	LA
2	1041C0700X	Clinical Social Worker	SW 9156	FL
3	1041C0700X	Clinical Social Worker	C8228	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831569235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN MICHELE VAN CHOFF LCSW

Provider Business Mailing Address
First Line	:	15520 DANIEL BLVD STE E
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-4744
Country	:	US
Telephone Number	:	228-314-3626
Fax Number	:	228-314-3141

Provider Business Practice Location Address
First Line	:	2059 E PASS RD STE 4
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3761
Country	:	US
Telephone Number	:	228-314-3626
Fax Number	:

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	02/22/2022

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