Organization
JASON G STENTOUMIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON G STENTOUMIS PHD (OWNER)
(517) 999-3935
Entity
Organization
Contact information
Practice address
2535 E MOUNT HOPE AVE, LANSING, MI 48910-1913
(517) 999-3935
(517) 372-2542
Mailing address
PO BOX 2257, CHESTERTON, IN 46304-0357
(517) 676-9788
(517) 676-3438
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013410
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680C315670
BLUE SHIELD OF MICHIGAN
MI
Enumeration date
02/01/2008
Last updated
04/09/2013
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