Individual
JONATHAN ROYCE VANDERVLUGT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHCA
Contact information
Practice address
9614 GRANADA CT APT 111, CROWN POINT, IN 46307-2161
(773) 732-1155
Mailing address
9614 GRANADA CT APT 111, CROWN POINT, IN 46307-2161
(773) 732-1155
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
10/05/2020
Last updated
10/12/2020
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