Provider Demographics
NPI:1770720195
Name:STEWART, JO ANNA (LMHC)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANNA
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:1125 BETHEL AVENUE
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1900
Mailing Address - Country:US
Mailing Address - Phone:360-620-3722
Mailing Address - Fax:360-443-4200
Practice Address - Street 1:820 PACIFIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-620-3722
Practice Address - Fax:855-210-4508
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60184226101YM0800X
WARC00056611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
93862OtherNCMHCE-CBT