Healthcare Provider Details

I. General information

NPI: 1659490795
Provider Name (Legal Business Name): DELORES F STEWART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 N STATE ST
OREM UT
84057-2025
US

IV. Provider business mailing address

PO BOX 970545
OREM UT
84097-0545
US

V. Phone/Fax

Practice location:
  • Phone: 801-229-2089
  • Fax: 801-224-8301
Mailing address:
  • Phone: 801-228-9900
  • Fax: 801-224-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3708166004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: