NPIMap

Organization Active NPI

Sage Tree Psychology Group LLC

  • Psychologist
  • Oxford, MI
National Provider Identifier
1265979397
Registry record updated Jan 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301013477 Issued in MI
Legal business name
SAGE TREE PSYCHOLOGY GROUP LLC
Practice address
925 N Lapeer Rd
Ste 151
Oxford, MI 48371-6742
Phone
(248) 303-1382
NPI assigned
Jan 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2017

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

Authorized official

Name
Dr. Dawn Bane Gventer, PSY.DNPI 1669470266
Title
Psychologist
Phone
(248) 303-1382

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 6301013477 MI Primary

Addresses

Primary practice location

925 N Lapeer Rd
Ste 151
Oxford, MI 48371-6742

Mailing address

1179 Bellwood CT
Oxford, MI 48371-6732
Phone (248) 303-1382

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170210002122 MI Part B Supplier - Clinic/Group Practice 7416230792 Receives reassigned benefits from 1 practitioner
Practice locations: Oxford, MI

National Provider Directory

National Provider Directory

Locations

925 N Lapeer Rd
Ste 151
Oxford, MI 48371
Phone (248) 303-1382

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485561600000",
    "number": "1265979397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 BELLWOOD CT",
            "city": "OXFORD",
            "state": "MI",
            "postal_code": "483716732",
            "telephone_number": "248-303-1382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 N LAPEER RD",
            "address_2": "STE 151",
            "city": "OXFORD",
            "state": "MI",
            "postal_code": "483716742",
            "telephone_number": "248-303-1382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE TREE PSYCHOLOGY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2017-01-28",
        "status": "A",
        "authorized_official_last_name": "GVENTER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "BANE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "248-303-1382",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301013477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.