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NPI Code Detail

MEDICARE: RETHA JONES STEWART

MEDICARE: RETHA JONES STEWART
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1740617372
Entity Type Code : Individual
Provider Name (Legal Business Name) : RETHA JONES STEWART
Provider Business Mailing Address
First Line : 7450 S EASTERN AVE
Second Line : 1017
City : LAS VEGAS
State : NV
Zip : 89123-1557
Country : US
Telephone Number : 817-504-2484
Fax Number :
Provider Business Practice Location Address
First Line : 7450 S EASTERN AVE
Second Line : 1017
City : LAS VEGAS
State : NV
Zip : 89123-1557
Country : US
Telephone Number : 817-504-2484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2013
Last Update Date : 09/27/2013

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