Provider Demographics
NPI:1740323351
Name:STEWART, TABITHA L (LPC, LSOTP, LCDC)
Entity type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC, LSOTP, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4018
Mailing Address - Country:US
Mailing Address - Phone:281-999-4859
Mailing Address - Fax:281-447-1722
Practice Address - Street 1:505 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 308
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4018
Practice Address - Country:US
Practice Address - Phone:281-999-4859
Practice Address - Fax:281-447-1722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10012656OtherAMERIGROUP
TX7152LCOtherBCBS