Provider Demographics
NPI:1376931212
Name:STEWART, ALEXIS KAYE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:KAYE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 KATIE LANE LOOP
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4324
Mailing Address - Country:US
Mailing Address - Phone:419-340-1504
Mailing Address - Fax:
Practice Address - Street 1:2668 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:KINGMAN CBOC
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401
Practice Address - Country:US
Practice Address - Phone:928-692-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI14508251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical