Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6401003604 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301002548 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | MI |
NPI | 1639398795 |
---|---|
Provider Name | Dr. Timothy Edgar Stewart |
First Address | Plainwell, MI 49080-1811 |
Second Address | Plainwell, MI 49080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |