Provider Demographics
NPI:1902079387
Name:STUART, ANITA LOUISE (LPC LADC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LOUISE
Last Name:STUART
Suffix:
Gender:F
Credentials:LPC LADC
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:LOUISE
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC LADC
Mailing Address - Street 1:2830 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1714
Mailing Address - Country:US
Mailing Address - Phone:612-728-8923
Mailing Address - Fax:
Practice Address - Street 1:3450 OLEARY LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2340
Practice Address - Country:US
Practice Address - Phone:651-454-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNADC300947101YA0400X
MNLPC00288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)