Provider Demographics
NPI:1528379799
Name:BAHR, STACEY RENEE (BSW, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:BAHR
Suffix:
Gender:F
Credentials:BSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6818
Mailing Address - Country:US
Mailing Address - Phone:517-346-9534
Mailing Address - Fax:517-346-8170
Practice Address - Street 1:812 E JOLLY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6818
Practice Address - Country:US
Practice Address - Phone:517-346-9534
Practice Address - Fax:517-346-8170
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010856261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical