MEDICARE: LISA MICHELLE STEWART PH.D.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417139494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELLE STEWART PH.D.

Provider Business Mailing Address
First Line	:	1920 SW RIVER DR
Second Line	:	906
City	:	PORTLAND
State	:	OR
Zip	:	97201-8048
Country	:	US
Telephone Number	:	971-255-0362
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 AUMSVILLE HWY SE
Second Line	:	MARION COUNTY JAIL
City	:	SALEM
State	:	OR
Zip	:	97317-9112
Country	:	US
Telephone Number	:	503-581-1183
Fax Number	:

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

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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