Healthcare Provider Details

I. General information

NPI: 1679772420
Provider Name (Legal Business Name): JACQUELINE KAY STEWART M.A., M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29141 VALLEJO AVE
TEMECULA CA
92592-2319
US

IV. Provider business mailing address

PO BOX 537
LAKE ELSINORE CA
92531-0537
US

V. Phone/Fax

Practice location:
  • Phone: 714-264-2739
  • Fax:
Mailing address:
  • Phone: 714-264-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT39270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: