Individual
DR. JUDY L TANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
790 W LAKE LANSING RD STE 500, EAST LANSING, MI 48823-8505
(517) 351-4442
Mailing address
PO BOX 10, MASON, MI 48854-0010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301003225
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008702
VALUE OPTIONS PROV NUMBER
MI
01
—
1217178000
MAGELLAN BEH HEALTH MIS
MI
01
—
680C34568
BCBS MICHIGAN
MI
Enumeration date
11/29/2005
Last updated
01/28/2020
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