Individual
MS. MALLORY BETH VAN FOSSEN
Active
Individual
MS. MALLORY BETH VAN FOSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATR-BC, LCPAT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
ATC054
MD
101YP2500X
Professional Counselor
PC007489
PA
221700000X
Art Therapist
Primary
ATC054
MD
Other
Enumeration date
02/26/2014
Last updated
02/01/2025
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