Healthcare Provider Details

I. General information

NPI: 1548717754
Provider Name (Legal Business Name): STEWART VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CUSTER DR STE 300 AND STE 302
LEXINGTON KY
40517-4010
US

IV. Provider business mailing address

3150 CUSTER DR STE 300 AND STE 302
LEXINGTON KY
40517-4010
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-0434
  • Fax: 859-368-0437
Mailing address:
  • Phone: 859-368-0434
  • Fax: 859-368-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN C. STEWART
Title or Position: OWNER
Credential:
Phone: 859-368-0434