Provider Demographics
NPI:1679845747
Name:STEWART, CHRISTOPHER KEITH (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KEITH
Last Name:STEWART
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MAIN ST
Mailing Address - Street 2:SUITE #204
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4203
Mailing Address - Country:US
Mailing Address - Phone:832-998-4320
Mailing Address - Fax:830-997-0132
Practice Address - Street 1:150 E MAIN ST
Practice Address - Street 2:SUITE #204
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4203
Practice Address - Country:US
Practice Address - Phone:830-998-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist