Provider Demographics
NPI:1043423890
Name:STEWART, THOMAS RICHARD (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHARD
Last Name:STEWART
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-3757
Mailing Address - Country:US
Mailing Address - Phone:606-560-5954
Mailing Address - Fax:616-975-3163
Practice Address - Street 1:4670 FULTON ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8455
Practice Address - Country:US
Practice Address - Phone:616-560-5954
Practice Address - Fax:616-975-3163
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011054103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling