=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164045670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELWYN RONEA STEWART-WINROW, PSYD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2020
-----------------------------------------------------
Last Update Date | 05/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7120 MCCART AVE STE 200
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-7298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-980-8669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7120 MCCART AVE STE 200
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-7298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-980-8669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SELWYN RONEA STEWART WINROW
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 817-980-8669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------