Provider Demographics
NPI:1154502771
Name:BAYNHAM, STACY MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELLE
Last Name:BAYNHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 HIGHCREST DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3006
Mailing Address - Country:US
Mailing Address - Phone:816-277-2305
Mailing Address - Fax:
Practice Address - Street 1:2035 HIGHCREST DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3006
Practice Address - Country:US
Practice Address - Phone:816-277-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical