Provider Demographics
NPI:1083022537
Name:STEWART, TIMOTHY (MACP, MDIV, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:MACP, MDIV, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SW 43RD ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4803
Mailing Address - Country:US
Mailing Address - Phone:425-496-4411
Mailing Address - Fax:
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 111
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:425-496-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60252548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health