Provider Demographics
NPI:1235906157
Name:STEWART, TONY BARNETT JR
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:BARNETT
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 MORENDO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1608
Mailing Address - Country:US
Mailing Address - Phone:702-931-6530
Mailing Address - Fax:
Practice Address - Street 1:5520 MORENDO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1608
Practice Address - Country:US
Practice Address - Phone:702-931-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician