Provider Demographics
NPI:1891682605
Name:VANGORDER, GEOFFREY (PSYS)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:VANGORDER
Suffix:
Gender:M
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2923
Mailing Address - Country:US
Mailing Address - Phone:248-345-9578
Mailing Address - Fax:
Practice Address - Street 1:1308 LONGFELLOW DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2923
Practice Address - Country:US
Practice Address - Phone:248-345-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist