Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35150 | TX |
Y | 103T00000X | Psychologist | 35150 | TX |
NPI | 1013281492 |
---|---|
Provider Name | Dr. Stacy Stewart |
First Address | West Lake Hills, TX 78746-5474 |
Second Address | West Lake Hills, TX 78746-5474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 01/03/2012 |