Provider Demographics
NPI:1346724010
Name:VANDERKAAY, JOHN D (DMIN, LMFT-S)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:VANDERKAAY
Suffix:
Gender:M
Credentials:DMIN, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N THOMPSON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2577
Mailing Address - Country:US
Mailing Address - Phone:936-703-5029
Mailing Address - Fax:
Practice Address - Street 1:702 N THOMPSON ST STE 120
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2577
Practice Address - Country:US
Practice Address - Phone:936-703-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
TX203148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral