Grow Your Mind Therapy

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

GROW YOUR MIND THERAPY

Practice address

1 Parklane Blvd Ste 1200E
Dearborn, MI 48126-4244

Phone

(313) 608-5544

NPI assigned

Oct 10, 2022

Organization subpart

No

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

Authorized official

Name

Stephanie Lake, LMSWNPI 1871008367

Title

Social Work/Therapist

Phone

(313) 608-5544

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Stephanie Denise Lake, LMSW

  • Social Worker
  • Dearborn, MI
  • NPI 1871008367
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674864000000",
    "number": "1992420251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23131 MICHIGAN AVE # 1168",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242020",
            "telephone_number": "313-608-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARKLANE BLVD STE 1200E",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264244",
            "telephone_number": "313-608-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROW YOUR MIND THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2023-01-28",
        "certification_date": "2023-01-28",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SOCIAL WORK/THERAPIST",
        "authorized_official_telephone_number": "313-608-5544",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alonzo Gerrard Groggins, ATC, AT
• Hailey Lynn Gross
• Jennifer Michelle Gross, M.ED., BCBA, LBA
• Group Vision Center, Inc.
• Group Vision Center, Inc.
• Hajer N Gsouda I
• Guat Sy Jr MD PC
• Cynthia Makayla Guelette
• Heather L Guernsey, SLP
• Kelcey Goodwin Guerriero

• Social Worker in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2023; 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.