Provider Demographics
NPI:1275396665
Name:VANNEST, JASON (PHD, LPC, RPT-S)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:VANNEST
Suffix:
Gender:M
Credentials:PHD, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 BAYTREE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-2300
Mailing Address - Country:US
Mailing Address - Phone:810-516-8877
Mailing Address - Fax:
Practice Address - Street 1:1955 W HAMLIN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3338
Practice Address - Country:US
Practice Address - Phone:810-516-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty