Provider Demographics
NPI:1477697514
Name:STEWART MENTAL HEALTH
Entity Type:Organization
Organization Name:STEWART MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:615-384-7111
Mailing Address - Street 1:105 5TH AVE W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2436
Mailing Address - Country:US
Mailing Address - Phone:615-384-7111
Mailing Address - Fax:615-384-5577
Practice Address - Street 1:105 5TH AVE W
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2436
Practice Address - Country:US
Practice Address - Phone:615-384-7111
Practice Address - Fax:615-384-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8127261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513631Medicaid
TN3370086Medicare PIN