Provider Demographics
NPI:1851965339
Name:STACY CARMICHAEL PHD LLC
Entity Type:Organization
Organization Name:STACY CARMICHAEL PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-415-1450
Mailing Address - Street 1:663 E PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3144
Mailing Address - Country:US
Mailing Address - Phone:727-481-2444
Mailing Address - Fax:321-234-5587
Practice Address - Street 1:310 S DILLARD ST STE 160
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3500
Practice Address - Country:US
Practice Address - Phone:407-415-1450
Practice Address - Fax:321-234-5587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STACY CARMICHAEL PHD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679122048OtherDR. VISTA NPI
1275667750OtherNPI
1063771376OtherGABY ZERPA LMHC NPI