Provider Demographics
NPI:1093239709
Name:STEWART, TANNISHA (LMHC)
Entity Type:Individual
Prefix:
First Name:TANNISHA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2080
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-2387
Practice Address - Street 1:1061 W OAKLAND PARK BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1600
Practice Address - Country:US
Practice Address - Phone:954-327-4060
Practice Address - Fax:954-792-9122
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH15081OtherPROFESSIONAL LICENSE