Provider Demographics
NPI:1639841562
Name:STEWART, BETTIE ALICIA
Entity Type:Individual
Prefix:
First Name:BETTIE
Middle Name:ALICIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40511 NORTH FORBES RD
Mailing Address - Street 2:APARTMENT 120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511
Mailing Address - Country:US
Mailing Address - Phone:502-542-4854
Mailing Address - Fax:
Practice Address - Street 1:40511 NORTH FORBES RD
Practice Address - Street 2:APT.120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511
Practice Address - Country:US
Practice Address - Phone:502-542-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging