Individual
D JOHN VANDERBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD HSPP
Contact information
Practice address
515 BAYOU ST, VINCENNES, IN 47591-1034
(812) 886-6800
(812) 886-6809
Mailing address
515 BAYOU ST, VINCENNES, IN 47591-1034
(812) 886-6800
(812) 886-6809
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20010229A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188719
ANTHEM BLUE CROSS
IN
05
—
200018450
—
IN
Enumeration date
12/29/2005
Last updated
07/31/2008
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