MEDICARE: KENDRA ALAIN STEWART LPC

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	2005026313	MO

General Provider Information

NPI Number	:	1558573014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA ALAIN STEWART LPC

Provider Business Mailing Address
First Line	:	4333 FOREST PARK AVE
Second Line	:	#1W
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2850
Country	:	US
Telephone Number	:	314-721-4673
Fax Number	:	314-721-8850

Provider Business Practice Location Address
First Line	:	7247 OLIVE BLVD
Second Line	:	SUITE B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2322
Country	:	US
Telephone Number	:	314-721-4673
Fax Number	:	314-721-8850

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/09/2007

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