Provider Demographics
NPI:1215215181
Name:STEIN MANN INSTITUTE, LLC
Entity Type:Organization
Organization Name:STEIN MANN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SUGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-716-4284
Mailing Address - Street 1:10 W BROADWAY STE 820
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2000
Mailing Address - Country:US
Mailing Address - Phone:801-716-4284
Mailing Address - Fax:801-433-0691
Practice Address - Street 1:10 W BROADWAY STE 820
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2000
Practice Address - Country:US
Practice Address - Phone:801-290-5320
Practice Address - Fax:801-290-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6278375-2501103G00000X
UT7821510-1205261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty