Individual
SHANE AARON VAN FOSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CO70013818
Contact information
Practice address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 356-7761
(360) 219-6843
Mailing address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 356-7761
(360) 425-5990
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO70013818
WA
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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