Stacy Carmichael PHD LLC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

STACY CARMICHAEL PHD LLC

Practice address

310 S Dillard St Ste 160
Winter Garden, FL 34787-3500

Phone

(407) 415-1450

Fax

(321) 234-5587

NPI assigned

May 18, 2021

Organization subpart

Yes

Parent organization

STACY CARMICHAEL PHD LLCAs reported in NPPES

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

Authorized official

Name

Dr. Stacy Lynn Carmichael, PHDNPI 1487858403

Title

Owner

Phone

(407) 415-1450

Specialties & licenses 6

Addresses

Other identifiers 3

Other names 1

• MindWorks Psychological Services Doing business as

Electronic endpoints 1

Part of

Stacy Carmichael PHD LLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Lynn Carmichael, PH.D.

  • Psychologist
  • Winter Garden, FL
  • NPI 1487858403

  Clinical Child & Adolescent

  NPD Authorized official

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

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1851965339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "663 E PLANT ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873144",
            "telephone_number": "727-481-2444",
            "fax_number": "321-234-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S DILLARD ST STE 160",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873500",
            "telephone_number": "407-415-1450",
            "fax_number": "321-234-5587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7450 Dr Phillips Blvd Ste 312",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328195428",
            "country_code": "US",
            "telephone_number": "407-415-1450",
            "fax_number": "321-234-5587",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STACY CARMICHAEL PHD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STACY CARMICHAEL PHD LLC",
        "enumeration_date": "2021-05-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "CARMICHAEL",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-415-1450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. VISTA NPI",
            "identifier": "1679122048",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275667750",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GABY ZERPA LMHC NPI",
            "identifier": "1063771376",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "3212345587",
            "affiliation": "N",
            "endpointDescription": "fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fax",
            "address_1": "663 E Plant St",
            "city": "Winter Garden",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347873144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MindWorks Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Shannon Steens, MA

• Clinical Child & Adolescent Psychologist in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.