Provider Demographics
NPI:1326450677
Name:STEWART, LYNETTE (CADC)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:HALLESY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:2 IDAHO WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7209
Mailing Address - Country:US
Mailing Address - Phone:702-565-6060
Mailing Address - Fax:702-565-6097
Practice Address - Street 1:2 IDAHO WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7209
Practice Address - Country:US
Practice Address - Phone:702-565-6060
Practice Address - Fax:702-565-6097
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00309-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)