Provider Demographics
NPI:1689197865
Name:STEWARD, TERIA LAVAVIA
Entity Type:Individual
Prefix:MS
First Name:TERIA
Middle Name:LAVAVIA
Last Name:STEWARD
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 1:5135 CAMINO AL NORTE STE 114
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2390
Mailing Address - Country:US
Mailing Address - Phone:702-353-1786
Mailing Address - Fax:702-965-2455
Practice Address - Street 1:5135 CAMINO AL NORTE STE 114
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2390
Practice Address - Country:US
Practice Address - Phone:702-353-1786
Practice Address - Fax:702-353-1786
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV47-1384714Medicaid