Healthcare Provider Details

I. General information

NPI: 1265458079
Provider Name (Legal Business Name): BRET HANSEN STEWART MSW, LCSW, PCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1898 FORT RD
SHERIDAN WY
82801-8320
US

IV. Provider business mailing address

6900 N PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-3473
  • Fax: 307-672-3911
Mailing address:
  • Phone: 702-971-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number01099152
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number252
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number554
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: