Individual
PETER JOHN VANDERSTEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMHC, LCPC, CADC
Contact information
Practice address
403 PONDEROSA CT APT 101, MOSCOW, ID 83843-3453
(208) 717-1130
Mailing address
403 PONDEROSA CT APT 101, MOSCOW, ID 83843-3453
(208) 717-1130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-5045
ID
101YM0800X
Mental Health Counselor
Primary
LCPC-9428
ID
101YM0800X
Mental Health Counselor
LH60898613
WA
Other
Enumeration date
10/10/2014
Last updated
01/08/2024
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