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NPI Code Detail

MEDICARE: ESSENTIAL SELF COUNSELING, P.A. DBA TOM STEWARD, P.A.

MEDICARE: ESSENTIAL SELF COUNSELING, P.A. DBA TOM STEWARD, P.A.
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor
3106H00000XMarriage & Family Therapist
41041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255605713
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESSENTIAL SELF COUNSELING, P.A. DBA TOM STEWARD, P.A.
Provider Business Mailing Address
First Line : 62 GRAND CANYON DR
Second Line :
City : WHITE ROCK
State : NM
Zip : 87547-3400
Country : US
Telephone Number : 505-412-0010
Fax Number : 505-451-5129
Provider Business Practice Location Address
First Line : 3250 TRINITY DR STE C
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-2226
Country : US
Telephone Number : 505-412-0010
Fax Number :
Authorized Official
Title or Position : OWNER
Name : THOMAS S. STEWARD
Credential :
Telephone Number : 505-412-0010
Provider Enumeration Date : 03/01/2012
Last Update Date : 12/20/2024

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