Provider Demographics
NPI:1568896108
Name:STEWART, TRACY L (MA, MED, LMHC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 UNIVERSITY WAY NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4424
Mailing Address - Country:US
Mailing Address - Phone:425-502-5699
Mailing Address - Fax:
Practice Address - Street 1:4730 UNIVERSITY WAY NE
Practice Address - Street 2:STE 104, #2332
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4424
Practice Address - Country:US
Practice Address - Phone:425-502-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60425035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID