MEDICARE: MS. STACY COLLEEN NUAR PSYD, LP

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	103TC0700X	Clinical Psychologist	6301019829	MI

General Provider Information

NPI Number	:	1831323658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY COLLEEN NUAR PSYD, LP

Provider Business Mailing Address
First Line	:	30146 WOODBROOK CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3061
Country	:	US
Telephone Number	:	248-330-0748
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 W MAPLE RD STE 145
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4471
Country	:	US
Telephone Number	:	734-719-0504
Fax Number	:

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	03/02/2026

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