Sanford Behavioral Health Outpatient LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

SANFORD BEHAVIORAL HEALTH OUTPATIENT LLC

Doing business as

Sanford Behavioral Health Outpatient LLC

Practice address

15146 16TH Ave
Marne, MI 49435-9605

Phone

(844) 776-9651

NPI assigned

Aug 11, 2022

Last updated

Aug 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Robinson

Title

Credentialing & Contracting Manager

Phone

(616) 520-9074

Specialties & licenses 6

Addresses

Other names 1

• Sanford Behavioral Health Outpatient LLC Doing business as

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1679201271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15146 16TH AVE",
            "city": "MARNE",
            "state": "MI",
            "postal_code": "494359605",
            "telephone_number": "844-776-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15146 16TH AVE",
            "city": "MARNE",
            "state": "MI",
            "postal_code": "494359605",
            "telephone_number": "844-776-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD BEHAVIORAL HEALTH OUTPATIENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING & CONTRACTING MANAGER",
        "authorized_official_telephone_number": "616-520-9074"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanford Behavioral Health Outpatient LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Behavioral Health Outpatient LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kylie Pershey
• Radiant Life Therapies LLC
• Lisa Helen Rector, MA-LPC
• Kaylie Reed
• Matthew Andrew Robinson, PHARM.D
• Sanford Psych Services LLC (Sanford West Psych Services)
• Sanford West LLC (Sanford West Behavioral Health Services)
• Sanford West LLC (Sanford West Behavioral Health Services ED)
• Kaitlyn Ilene Seiter, LLMSW
• Nicholas James Selzer

• Multi-Specialty Clinic/Center in Marne, MI
• Providers in Marne, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.