Healthcare Provider Details

I. General information

NPI: 1619890795
Provider Name (Legal Business Name): BETHANY LYNN STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 210
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

7012 LUZ DEL SOL PL NW
ALBUQUERQUE NM
87114-3696
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-8580
  • Fax: 505-332-3148
Mailing address:
  • Phone: 505-355-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: