Provider Demographics
NPI:1093314627
Name:MORNING TEA THERAPY
Entity Type:Organization
Organization Name:MORNING TEA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BICSAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-570-4783
Mailing Address - Street 1:17190 NORBORNE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2231
Mailing Address - Country:US
Mailing Address - Phone:313-467-8657
Mailing Address - Fax:
Practice Address - Street 1:17190 NORBORNE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2231
Practice Address - Country:US
Practice Address - Phone:313-467-8657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty