Provider Demographics
NPI:1124666714
Name:IN OUR PRACTICE PSYCHOTHERAPY PRIVATE PRACTICE
Entity type:Organization
Organization Name:IN OUR PRACTICE PSYCHOTHERAPY PRIVATE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ATHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-272-3727
Mailing Address - Street 1:3400 SHATTUCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3157
Mailing Address - Country:US
Mailing Address - Phone:989-272-3727
Mailing Address - Fax:989-355-0447
Practice Address - Street 1:3400 SHATTUCK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3157
Practice Address - Country:US
Practice Address - Phone:989-272-3727
Practice Address - Fax:989-355-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty