Healthcare Provider Details

I. General information

NPI: 1417079302
Provider Name (Legal Business Name): CYRUS SHEPHARD STEWART PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 PARK LAKE ROAD MERIDIAN PROFESSIONAL PSYCHOLOGICAL CONSULTANTS
EAST LANSING MI
48823-3835
US

IV. Provider business mailing address

5031 PARK LAKE ROAD MERIDIAN PROFESSIONAL PSYCHOLOGICAL CONSULTANTS
EAST LANSING MI
48823-3835
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-0811
  • Fax: 517-332-4452
Mailing address:
  • Phone: 517-332-0811
  • Fax: 517-332-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801017511
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: