Healthcare Provider Details

I. General information

NPI: 1124089099
Provider Name (Legal Business Name): JOSEPH RICHARD SANOK MA, LLP, LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 HOLIDAY TER
KALAMAZOO MI
49009-2196
US

IV. Provider business mailing address

4329 GULL PRAIRIE DR APT 2B
KALAMAZOO MI
49048-3054
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-4140
  • Fax: 269-372-0390
Mailing address:
  • Phone: 231-590-9852
  • Fax: 269-372-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009160
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009160
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012786
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301012786
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6301012786
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: