Healthcare Provider Details

I. General information

NPI: 1952745028
Provider Name (Legal Business Name): ROSS STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14180 DALLAS PKWY STE 520
DALLAS TX
75254-1334
US

IV. Provider business mailing address

14180 DALLAS PKWY STE 520
DALLAS TX
75254-1334
US

V. Phone/Fax

Practice location:
  • Phone: 972-248-0780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number7388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: