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NPI Code Detail

MEDICARE: MS. STACEY LYNN-CHURCHILL SMYCZYNSKI LMSW

MEDICARE: MS. STACEY LYNN-CHURCHILL SMYCZYNSKI LMSW
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
1101YM0800XMental Health Counselor6801104994MI
21041C0700XClinical Social Worker6801104994MI

General Provider Information

NPI Number : 1831796499
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACEY LYNN-CHURCHILL SMYCZYNSKI LMSW
Provider Business Mailing Address
First Line : 1511 W CARPENTER ST
Second Line :
City : MIDLAND
State : MI
Zip : 48640-4339
Country : US
Telephone Number : 989-878-1716
Fax Number :
Provider Business Practice Location Address
First Line : 1025 W WASHINGTON ST STE B
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4031
Country : US
Telephone Number : 989-267-0071
Fax Number : 989-267-0230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2020
Last Update Date : 12/17/2024

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