| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MYRA ANN STARK | 1730547811 | 2022-06-19 |
Myra Ann Stark is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1730547811. Registration indicates Myra Ann Stark is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) Access to Mental Health/Behavioral Health Providers (Behavioral Health & Social Service Providers, Social Worker) (Behavioral Health & Social Service Providers, Social Worker) (Social Worker, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker, Behavioral Health & Social Service Providers)
| Entity Type | Individual |
| Provider Name | Myra Ann Stark MSW |
| Other Provider Name | Myra Ann Sandford |
| Practice Office Address | 185 44TH ST SW STE B GRANDVILLE, MI US |
| Practice Office Telephone | 6162442246 |
| Practice Office Fax | 6162442247 |
| Mailing Address | 185 44TH ST SW STE B GRANDVILLE, MI 494183363 US |
| Business Telephone | 6162442246 |
| Business Fax | 6162442247 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | |
| 104100000X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker Behavioral Health/Substance Abuse/Psychiatry Social Worker Behavioral Health & Social Service Providers | 6801104031
MI |
| 6801104031 | MEDICAID | MI |