Provider Demographics
NPI:1093847766
Name:MACLEAN HEALY, STACY (MA LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MACLEAN HEALY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 FRANCIS STREET
Mailing Address - Street 2:
Mailing Address - City:CAMLACHIE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N0N1E0
Mailing Address - Country:CA
Mailing Address - Phone:519-869-2209
Mailing Address - Fax:
Practice Address - Street 1:1600 GRATIOT BLVD STE 4 BLDG B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-5800
Practice Address - Fax:810-364-1200
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6404005870101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor