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General NPI Number Information
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NPI Number | 1043430184
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Entity Type | Individual
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Provider Name | YANIS PETERIS GRANTS DR PSYCH
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Gender | Male
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4341 S WESTNEDGE AV SUITE 2109
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City | KALAMAZOO
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State | MI
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Zip | 49008
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Country | US
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Telephone | 269-341-9300
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Fax | 269-384-8448
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Provider Business Mailing Address
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Address Line | 1616 DOVER RD
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City | KALAMAZOO
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State | MI
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Zip | 49008-2242
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Country | US
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Telephone | 269-217-1780
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Fax | 269-384-8448
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005437
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License Number State | MI
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