Provider Demographics
NPI:1043430184
Name:GRANTS, YANIS PETERIS (DR PSYCH)
Entity Type:Individual
Prefix:DR
First Name:YANIS
Middle Name:PETERIS
Last Name:GRANTS
Suffix:
Gender:M
Credentials:DR PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2242
Mailing Address - Country:US
Mailing Address - Phone:269-217-1780
Mailing Address - Fax:269-384-8448
Practice Address - Street 1:4341 S WESTNEDGE AV
Practice Address - Street 2:SUITE 2109
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008
Practice Address - Country:US
Practice Address - Phone:269-341-9300
Practice Address - Fax:269-384-8448
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist