Provider Demographics
NPI:1760550909
Name:STEWART, NICOLE (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 REGATA RUN DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-7431
Mailing Address - Country:US
Mailing Address - Phone:281-200-9210
Mailing Address - Fax:713-400-3549
Practice Address - Street 1:303 JACKSON HILL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7407
Practice Address - Country:US
Practice Address - Phone:713-986-3300
Practice Address - Fax:713-986-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18911101YM0800X
TX5090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171048501Medicaid