Provider Demographics
NPI:1821784661
Name:ANTON, ABAGAYLE
Entity Type:Individual
Prefix:
First Name:ABAGAYLE
Middle Name:
Last Name:ANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16925 ABILITY WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9325
Mailing Address - Country:US
Mailing Address - Phone:616-935-7606
Mailing Address - Fax:
Practice Address - Street 1:16925 ABILITY WAY
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9325
Practice Address - Country:US
Practice Address - Phone:616-935-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRBT-23-260271106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician