Provider Demographics
NPI:1851350904
Name:STEWART-DESECK, TERRY ELLEN (LIMHP, LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ELLEN
Last Name:STEWART-DESECK
Suffix:
Gender:F
Credentials:LIMHP, LCSW
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:ELLEN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:7516 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1312
Mailing Address - Country:US
Mailing Address - Phone:785-233-7962
Mailing Address - Fax:
Practice Address - Street 1:201 GALVIN RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4852
Practice Address - Country:US
Practice Address - Phone:402-779-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE777101YM0800X
NE1377104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
070655Medicare ID - Type Unspecified
70655OtherBCBS
KS200355870AMedicaid