Provider Demographics
NPI:1134425309
Name:STEWART, NICOLE ELISE (LMLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELISE
Other - Last Name:KIESLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMLP
Mailing Address - Street 1:645 E IRON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2697
Mailing Address - Country:US
Mailing Address - Phone:785-823-0001
Mailing Address - Fax:785-914-5250
Practice Address - Street 1:645 E IRON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2697
Practice Address - Country:US
Practice Address - Phone:785-823-0001
Practice Address - Fax:785-914-5250
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1486103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral