Provider Demographics
NPI:1730375106
Name:STENTOUMIS, JASON G (PSYD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:STENTOUMIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 OKEMOS RD STE B2
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4210
Mailing Address - Country:US
Mailing Address - Phone:517-999-3935
Mailing Address - Fax:517-798-5668
Practice Address - Street 1:3945 OKEMOS RD STE B2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4210
Practice Address - Country:US
Practice Address - Phone:517-999-3935
Practice Address - Fax:517-798-5668
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301013410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C315670OtherBLUE SHIELD OF MICHIGAN