John Richter Van Eenwyk, PHD

Primary specialty

Psychoanalysis PsychologistTaxonomy code 103TP0814X

License

PY00001787 Issued in WA

Practice address

1026 State Ave NE
Olympia, WA 98506-4065

Phone

(360) 352-2974

NPI assigned

Sep 12, 2008

Last updated

Oct 28, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288224000000",
    "number": "1093964181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064065",
            "telephone_number": "360-870-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064065",
            "telephone_number": "360-352-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN EENWYK",
        "first_name": "JOHN",
        "middle_name": "RICHTER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-12",
        "last_updated": "2010-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": "WA",
            "license": "PY00001787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Valentine
• Eleanor Valenzuela Ward, CDP
• Joshua William Valenzuela
• Van B. Ly, LLC
• Kimberly Van Dalsem, SPCT
• Leah J Van Tiem, CLINICIAN
• Kelli Vance
• Gregg K Vandekieft, M.D.
• Rachel Cecile Vandemark
• Monta Vander-Heyden, RN

• Psychoanalysis Psychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Psychoanalysis Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.