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General NPI Number Information
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NPI Number | 1255446498
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Entity Type | Individual
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Provider Name | TERESA JO STUART LSCSW, LCAC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 100 MILITARY AVE SUITE 116
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City | DODGE CITY
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State | KS
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Zip | 67801-4946
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Country | US
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Telephone | 620-338-2168
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Fax | 620-225-1311
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Provider Business Mailing Address
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Address Line | PO BOX 602
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City | BUCKLIN
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State | KS
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Zip | 67834-0602
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Country | US
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Telephone | 620-338-2168
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Fax | 620-225-1311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSCSW 2135
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAC 186
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License Number State | KS
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