Provider Demographics
NPI:1053328732
Name:STUART, MICHAEL D (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 EAST GRAND RIVER
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-545-5949
Mailing Address - Fax:517-545-7390
Practice Address - Street 1:2020 EAST GRAND RIVER
Practice Address - Street 2:SUITE 104
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-545-5944
Practice Address - Fax:517-545-7390
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082835104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker