Provider Demographics
NPI:1861967838
Name:STEWART, HOLLY MARIE (PYSD, LLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PYSD, LLP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HOLLY M TOMCZYK
Mailing Address - Street 1:PO BOX 80129
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0129
Mailing Address - Country:US
Mailing Address - Phone:313-378-3781
Mailing Address - Fax:
Practice Address - Street 1:2083 YARMUTH DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4075
Practice Address - Country:US
Practice Address - Phone:313-378-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherNA