Provider Demographics
NPI:1811261126
Name:VANZANT, JEFF CRAIG (MA)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:CRAIG
Last Name:VANZANT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 48TH AVE W
Mailing Address - Street 2:SUITE 202 PMB #30
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-6401
Mailing Address - Country:US
Mailing Address - Phone:206-679-4321
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:SUITE 202 PMB #30
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:206-679-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60163572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health