Provider Demographics
NPI:1871980177
Name:VANTIL, RICK (MA,LPC)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:VANTIL
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 BLACK LAKE WALK
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2392
Mailing Address - Country:US
Mailing Address - Phone:616-312-9742
Mailing Address - Fax:
Practice Address - Street 1:2359 BLACK LAKE WALK
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2392
Practice Address - Country:US
Practice Address - Phone:616-312-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health