MEDICARE: STACY M WRIGHT LLP, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301011415	MI
2	101YP2500X	Professional Counselor	6401008219	MI

General Provider Information

NPI Number	:	1164727442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY M WRIGHT LLP, LPC

Provider Business Mailing Address
First Line	:	3300 BERMUDA ST STE 323
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-3043
Country	:	US
Telephone Number	:	269-207-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 BERMUDA ST STE 323
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-3043
Country	:	US
Telephone Number	:	269-207-5896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	03/28/2026

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