Provider Demographics
NPI:1952548216
Name:VANLANT, KEVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:VANLANT
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 1:5182 KATELLA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2824
Mailing Address - Country:US
Mailing Address - Phone:562-618-4429
Mailing Address - Fax:562-799-1513
Practice Address - Street 1:5182 KATELLA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2824
Practice Address - Country:US
Practice Address - Phone:562-618-4429
Practice Address - Fax:562-799-1513
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical