Provider Demographics
NPI:1275084147
Name:STEWART, PATRICK (BS, MA, MFTI)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:BS, MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56949 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4166
Mailing Address - Country:US
Mailing Address - Phone:760-450-6149
Mailing Address - Fax:
Practice Address - Street 1:FATHERS HEART RANCH
Practice Address - Street 2:71175 AURORA RD.
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92241
Practice Address - Country:US
Practice Address - Phone:760-251-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA94392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator