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General NPI Number Information
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NPI Number | 1124666714
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Entity Type | Organization
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Legal Business Name | IN OUR PRACTICE PSYCHOTHERAPY PRIVATE PRACTICE
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Dates
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Enumeration Date | 12/15/2019
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 3400 SHATTUCK RD STE 2
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City | SAGINAW
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State | MI
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Zip | 48603-3157
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Country | US
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Telephone | 989-272-3727
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Fax | 989-355-0447
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Provider Business Mailing Address
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Address Line | 3400 SHATTUCK RD STE 2
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City | SAGINAW
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State | MI
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Zip | 48603-3157
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Country | US
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Telephone | 989-272-3727
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Fax | 989-355-0447
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | STACY LYNN ATHENS
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Credential | LMSW
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Telephone | 989-272-3727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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