Provider Demographics
NPI:1124252606
Name:VAN NESS, JOHN WARREN (LMHC, LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:VAN NESS
Suffix:
Gender:M
Credentials:LMHC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 140TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHURDAN
Mailing Address - State:IA
Mailing Address - Zip Code:50050-8555
Mailing Address - Country:US
Mailing Address - Phone:515-389-3291
Mailing Address - Fax:
Practice Address - Street 1:414 140TH STREET
Practice Address - Street 2:
Practice Address - City:CHURDAN
Practice Address - State:IA
Practice Address - Zip Code:50050-8555
Practice Address - Country:US
Practice Address - Phone:515-389-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00198101YM0800X
IA044101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical