1184689176 NPI number — MR. HAROLD T STEWART LCSW LADC CCS

Table of content: MR. HAROLD T STEWART LCSW LADC CCS (NPI 1184689176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184689176 NPI number — MR. HAROLD T STEWART LCSW LADC CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
HAROLD
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LADC CCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184689176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 COCHRANE CIR BLDG 7505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913-4604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-526-5231
Provider Business Mailing Address Fax Number:
719-526-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1076 SWITCH GRASS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80109-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-601-3252
Provider Business Practice Location Address Fax Number:
720-601-3252
Provider Enumeration Date:
04/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LC2593 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW09924354 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LC11050 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 295960099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: CCS3210 . This is a "CERTIFIED CLINICAL SUPER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".