Healthcare Provider Details

I. General information

NPI: 1639398795
Provider Name (Legal Business Name): TIMOTHY EDGAR STEWART PH.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHART ST
PLAINWELL MI
49080
US

IV. Provider business mailing address

121 HICKS AVE
PLAINWELL MI
49080-1811
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-6363
  • Fax:
Mailing address:
  • Phone: 269-569-5323
  • Fax: 269-685-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401003604
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301002548
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: