Provider Demographics
NPI:1144652405
Name:STEWART, TARA MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13736 ROYSTON BND
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5007
Mailing Address - Country:US
Mailing Address - Phone:631-786-5933
Mailing Address - Fax:
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:#201
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-584-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH14742OtherLMHC