Provider Demographics
NPI:1851763205
Name:STACY MCNEELY LMSW PLC
Entity Type:Organization
Organization Name:STACY MCNEELY LMSW PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MCNEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW, ACSW
Authorized Official - Phone:616-805-8341
Mailing Address - Street 1:425 LAKESHORE DR S
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2222
Mailing Address - Country:US
Mailing Address - Phone:616-805-8341
Mailing Address - Fax:616-258-2200
Practice Address - Street 1:36 W 8TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2701
Practice Address - Country:US
Practice Address - Phone:616-805-8341
Practice Address - Fax:616-258-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010884651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty