Provider Demographics
NPI:1669367249
Name:LAVENDER GROVE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:LAVENDER GROVE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:STADEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-444-3104
Mailing Address - Street 1:6272 S SAGINAW RD # 1073
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15102 THORNRIDGE DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8896
Practice Address - Country:US
Practice Address - Phone:810-444-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty