Basic Information
| Provider Information | |||||||||
| NPI: | 1720260219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN SLEEUWEN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 S ATLANTIC BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233189960 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 S ATLANTIC BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233189960 | ||||||||
| FaxNumber: | 3237803211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 42719 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.