Provider Demographics
NPI:1578838132
Name:SCHANTZ, AARON R (LLP)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:R
Last Name:SCHANTZ
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1410
Mailing Address - Country:US
Mailing Address - Phone:616-312-3175
Mailing Address - Fax:616-935-1288
Practice Address - Street 1:120 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1410
Practice Address - Country:US
Practice Address - Phone:616-312-3175
Practice Address - Fax:616-935-1288
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist