Provider Demographics
NPI:1306444393
Name:VAN ZOEREN, ANTHONIE AREND
Entity type:Individual
Prefix:
First Name:ANTHONIE
Middle Name:AREND
Last Name:VAN ZOEREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0203
Mailing Address - Country:US
Mailing Address - Phone:719-424-4653
Mailing Address - Fax:
Practice Address - Street 1:1257 LAKE PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3561
Practice Address - Country:US
Practice Address - Phone:719-424-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health