Individual provider Active NPI

Stephany Latham, LPC

  • Mental Health Counselor
  • Redford, MI
National Provider Identifier
1174076541
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
6401015419 Issued in MI
Practice address
9315 Telegraph Rd
Redford, MI 48239-1260
Phone
(313) 450-4500
NPI assigned
Aug 2, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401015419 MI
Art Therapist 221700000X
Mental Health Counselor 101YM0800X 6401015419 MI Primary

Addresses

Primary practice location

9315 Telegraph Rd
Redford, MI 48239-1260

Mailing address

9315 Telegraph Rd
Redford, MI 48239-1260
Phone (313) 450-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240327001199 MI Practitioner - Mental Health Counselor 0143667089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lincoln Behavioral ServicesGroup PAC ID 7113816612, 23 clinicians

Practice addresses (Care Compare)

9315 Telegraph Rd
Redford, MI 48239-1260
Phone (313) 450-4500

9329 Telegraph Rd
Redford, MI 48239-1260
Phone (313) 937-9500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401015419MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Behavioral Services CurrentSince Feb 10, 2024 Accepting new patients
Lincoln Behavioral Services CurrentSince Feb 10, 2024 Accepting new patients
Lifelab Kids Foundation Mental Health PastSince Dec 1, 2019 Accepting new patients

Locations

9315 Telegraph Rd
Redford, MI 48239
Phone (313) 937-9500

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1174076541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9315 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482391260",
            "telephone_number": "313-450-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9315 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482391260",
            "telephone_number": "313-450-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "STEPHANY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401015419",
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401015419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redford, MI

Sources for this page

Verify at the official NPI Registry.