1104971118 NPI number — SHIRLEE M STEWART LMSW LMFT

Table of content: SHIRLEE M STEWART LMSW LMFT (NPI 1104971118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104971118 NPI number — SHIRLEE M STEWART LMSW LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
SHIRLEE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW LMFT
Provider Gender Code:
F

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:
1104971118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 PRESTON RD STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-991-8080
Provider Business Mailing Address Fax Number:
972-991-8034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12700 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 260
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-991-8080
Provider Business Practice Location Address Fax Number:
972-991-8034
Provider Enumeration Date:
01/23/2007

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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