Provider Demographics
NPI:1790110724
Name:STEWART, TARA ELESIA (BA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELESIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:ELESIA
Other - Last Name:WOODYARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:3904 36TH TER S APT E
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4141
Mailing Address - Country:US
Mailing Address - Phone:727-824-5745
Mailing Address - Fax:727-823-1565
Practice Address - Street 1:647 34TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3730
Practice Address - Country:US
Practice Address - Phone:727-824-5745
Practice Address - Fax:727-823-1565
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor