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General NPI Number Information
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NPI Number | 1730708538
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Entity Type | Individual
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Provider Name | DYLAN VORIS PHD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 4523 E WILLOUGHBY RD.
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City | HOLT
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State | MI
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Zip | 48842
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Country | US
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Telephone | 517-796-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 4523 E WILLOUGHBY RD.
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City | HOLT
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State | MI
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Zip | 48842
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Country | US
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Telephone | 517-798-6631
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Fax |
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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 | 6301016988
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License Number State | MI
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