Provider Demographics
NPI:1952674699
Name:FOX, STACEY (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5725 VENTURE PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2816
Mailing Address - Country:US
Mailing Address - Phone:269-355-0725
Mailing Address - Fax:269-620-5985
Practice Address - Street 1:5725 VENTURE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2816
Practice Address - Country:US
Practice Address - Phone:269-355-0725
Practice Address - Fax:269-620-5985
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical