Provider Demographics
NPI:1841893369
Name:BISHOP, STACY HEATHER (LMSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:HEATHER
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 SHATTUCK RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3184
Mailing Address - Country:US
Mailing Address - Phone:989-475-4171
Mailing Address - Fax:989-393-6021
Practice Address - Street 1:3323 SHATTUCK RD STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3184
Practice Address - Country:US
Practice Address - Phone:810-422-7126
Practice Address - Fax:989-393-6021
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011046251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical