Provider Demographics
NPI:1164931572
Name:STEWART, KRISTINA (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
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 1:415 N 26TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2856
Mailing Address - Country:US
Mailing Address - Phone:765-446-6549
Mailing Address - Fax:765-446-6536
Practice Address - Street 1:41 N LONG AVE
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-8117
Practice Address - Country:US
Practice Address - Phone:765-762-6187
Practice Address - Fax:765-762-6188
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health