Provider Demographics
NPI:1821287459
Name:STEWART, NICKEY LEE (TRLPC 1900)
Entity Type:Individual
Prefix:
First Name:NICKEY
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:M
Credentials:TRLPC 1900
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 EAST 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4117
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:785-628-1438
Practice Address - Street 1:323 WEST 12TH STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3812
Practice Address - Country:US
Practice Address - Phone:785-623-2416
Practice Address - Fax:785-623-2418
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional