Healthcare Provider Details

I. General information

NPI: 1669367249
Provider Name (Legal Business Name): LAVENDER GROVE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 OFFICE PARK DR STE 1
GRAND BLANC MI
48439-2075
US

IV. Provider business mailing address

8308 OFFICE PARK DR STE 1
GRAND BLANC MI
48439-2075
US

V. Phone/Fax

Practice location:
  • Phone: 810-444-3104
  • Fax: 810-221-0287
Mailing address:
  • Phone: 810-444-3104
  • Fax: 810-221-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LEAH KATHERINE STADEL
Title or Position: PRACTICE OWNER/CLINICAL THERAPIST
Credential: LMSW
Phone: 810-444-3104