MEDICARE: CELENA STEWART MA,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083224281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELENA STEWART MA,

Provider Business Mailing Address
First Line	:	2011 LOUETTA RESERVE WAY
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4271
Country	:	US
Telephone Number	:	773-620-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 LOUETTA RESERVE WAY
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4271
Country	:	US
Telephone Number	:	773-620-3786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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Directions to “ CELENA STEWART MA,” Practice Location

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