Provider Demographics
NPI:1730521758
Name:STEWART, SHELBY ANN (LMFT, APCC)
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2542
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94927-2542
Mailing Address - Country:US
Mailing Address - Phone:707-326-8900
Mailing Address - Fax:
Practice Address - Street 1:110 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4189
Practice Address - Country:US
Practice Address - Phone:707-890-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10270101YP2500X
390200000X, 101YM0800X
CA152024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health