Provider Demographics
NPI:1275937583
Name:MORGAN, STACEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 OAKBURN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3767
Mailing Address - Country:US
Mailing Address - Phone:616-915-8153
Mailing Address - Fax:
Practice Address - Street 1:4403 CASCADE RD SE STE 8
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3673
Practice Address - Country:US
Practice Address - Phone:616-915-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical