Healthcare Provider Details

I. General information

NPI: 1144101734
Provider Name (Legal Business Name): STANCE HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W 1ST ST STE 113
FLINT MI
48502-1382
US

IV. Provider business mailing address

407 LINCOLN RD STE 6H
MIAMI BEACH FL
33139-3023
US

V. Phone/Fax

Practice location:
  • Phone: 313-604-8765
  • Fax: 888-657-2039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JON LARSON
Title or Position: PRESIDENT
Credential: MD
Phone: 313-604-8765