Provider Demographics
NPI:1710134358
Name:STEWART, JENNIFER MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S WASHINGTON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2610
Mailing Address - Country:US
Mailing Address - Phone:806-342-3900
Mailing Address - Fax:806-342-3903
Practice Address - Street 1:1800 S WASHINGTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2610
Practice Address - Country:US
Practice Address - Phone:806-342-3900
Practice Address - Fax:806-342-3903
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health