Provider Demographics
NPI:1942389481
Name:VANTOL, BRETT CORNELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CORNELL
Last Name:VANTOL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 PATIENT CARE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4275
Mailing Address - Country:US
Mailing Address - Phone:517-887-9801
Mailing Address - Fax:517-887-9826
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:517-887-9826
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TP2701X, 103TR0400X
MI6301008897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation