Provider Demographics
NPI:1578571535
Name:STUART, GRACE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MARIE
Last Name:STUART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7312
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77248-7312
Mailing Address - Country:US
Mailing Address - Phone:832-622-5518
Mailing Address - Fax:713-473-0070
Practice Address - Street 1:3522 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2134
Practice Address - Country:US
Practice Address - Phone:832-622-5518
Practice Address - Fax:713-473-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS005731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10011672OtherAMERIGROUP
275652000OtherMAGELLAN
TX107678801Medicaid
TX00567LMedicare ID - Type Unspecified