1922024918 NPI number — MS. CHRISTINE LOUISE STEWART LCSW

Table of content: MR. DOUGLAS A EVERHART RPH (NPI 1376987891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922024918 NPI number — MS. CHRISTINE LOUISE STEWART LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
CHRISTINE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENKINS
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922024918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-0390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-718-0044
Provider Business Mailing Address Fax Number:
317-745-5219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 MANOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-9400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-718-0044
Provider Business Practice Location Address Fax Number:
317-745-5219
Provider Enumeration Date:
07/14/2006

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: 104100000X , with the licence number:  34100083A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 270168 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7992006 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000176499 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11559642 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200225810A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222655000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000678921 . This is a "ANTHEM GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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