Edgar Carl De Van III, CAC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6541 Issued in CO

Practice address

615 Russell Ave
Walsenburg, CO 81089-2127

Phone

(719) 738-2076

NPI assigned

Jun 4, 2007

Last updated

Jul 8, 2007By 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215139019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 W 3RD ST",
            "city": "WALSENBURG",
            "state": "CO",
            "postal_code": "810891904",
            "telephone_number": "719-738-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 RUSSELL AVE",
            "city": "WALSENBURG",
            "state": "CO",
            "postal_code": "810892127",
            "telephone_number": "719-738-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VAN",
        "first_name": "EDGAR",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "CAC II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "6541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Walsenburg, CO
• Providers in Walsenburg, CO by specialty
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.