Provider Demographics
NPI:1649630047
Name:STEWART, THOMAS DERIN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DERIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S IH 35 STE 206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3873
Mailing Address - Country:US
Mailing Address - Phone:512-243-5032
Mailing Address - Fax:512-243-5034
Practice Address - Street 1:2101 S IH 35 STE 206
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3873
Practice Address - Country:US
Practice Address - Phone:512-243-5032
Practice Address - Fax:512-243-5034
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker