Provider Demographics
NPI:1700158615
Name:STEWART, DAVID K (MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:K
Last Name:STEWART
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12523 LIMONITE AVE
Mailing Address - Street 2:STE 440-210
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3665
Mailing Address - Country:US
Mailing Address - Phone:866-415-7049
Mailing Address - Fax:
Practice Address - Street 1:7223 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3812
Practice Address - Country:US
Practice Address - Phone:866-415-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist