Provider Demographics
NPI:1841480761
Name:VAN GELDER, MICHAEL JACOBUS (MS, MN, PMHNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOBUS
Last Name:VAN GELDER
Suffix:
Gender:M
Credentials:MS, MN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 N NEVADA ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1197
Mailing Address - Country:US
Mailing Address - Phone:509-591-9007
Mailing Address - Fax:509-593-4676
Practice Address - Street 1:9631 N NEVADA ST STE 209
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1197
Practice Address - Country:US
Practice Address - Phone:509-591-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201043039RN163WP0808X
OR201250114NP363LP0808X
WAAP60319975363LP0808X
WARC00057879101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor