Provider Demographics
NPI:1891290581
Name:GHANTOUS, YVETTE M
Entity Type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:M
Last Name:GHANTOUS
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 1:2444 E HILL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5098
Mailing Address - Country:US
Mailing Address - Phone:810-882-1738
Mailing Address - Fax:
Practice Address - Street 1:2444 E HILL RD STE 2
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5098
Practice Address - Country:US
Practice Address - Phone:810-820-4533
Practice Address - Fax:810-882-1738
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty