Stacey Lynn Tissue, LLBSW

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

6802086138 Issued in MI

Practice address

2875 Henry St
Port Huron, MI 48060-2526

Phone

(810) 987-9700

NPI assigned

Apr 1, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Clair County Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Marine City, MI
  • NPI 1821133265
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1043482854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4090 WELLMAN LINE RD",
            "city": "JEDDO",
            "state": "MI",
            "postal_code": "480328105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 HENRY ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480602526",
            "telephone_number": "810-987-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISSUE",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "credential": "LLBSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MI",
            "license": "6802086138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Dawn Thueme, FNP-C
• Thumb Physiatry PC
• Thumbcoast Transportation
• Lacey Timperley
• Lisa Tippit
• Suzanne Tomczak
• John M. Tomiuk, D.D.S.
• Stephanie Tople
• April Lynn Torz, LMSW
• Touching Hands LLC

• Case Manager/Care Coordinator in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Case Manager/Care Coordinator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.