Provider Demographics
NPI:1730484163
Name:STEPHEN J. VANGEL JR., PH.D.
Entity type:Organization
Organization Name:STEPHEN J. VANGEL JR., PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VANGEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-842-2930
Mailing Address - Street 1:3756 ELLISIA RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1724
Mailing Address - Country:US
Mailing Address - Phone:248-842-2930
Mailing Address - Fax:248-360-8897
Practice Address - Street 1:9640 COMMERCE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4166
Practice Address - Country:US
Practice Address - Phone:248-842-2930
Practice Address - Fax:248-360-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009301103G00000X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty