Healthcare Provider Details

I. General information

NPI: 1851221469
Provider Name (Legal Business Name): MICAH STEWART
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9241 S IL ROUTE 31
LAKE IN THE HILLS IL
60156-1607
US

IV. Provider business mailing address

1305 WILEY RD STE 131
SCHAUMBURG IL
60173-4354
US

V. Phone/Fax

Practice location:
  • Phone: 224-210-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: