Provider Demographics
NPI:1679248645
Name:LANTOR, MARILYN BERRIS (MA, LPC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:BERRIS
Last Name:LANTOR
Suffix:
Gender:F
Credentials:MA, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14323 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4839
Mailing Address - Country:US
Mailing Address - Phone:586-294-0770
Mailing Address - Fax:586-294-7880
Practice Address - Street 1:14323 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4839
Practice Address - Country:US
Practice Address - Phone:586-294-0770
Practice Address - Fax:586-294-7880
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000915225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor