MEDICARE: TRACY L. STEWART MA, MED, LMHC

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	101YP2500X	Professional Counselor	60425035	WA

General Provider Information

NPI Number	:	1568896108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY L. STEWART MA, MED, LMHC

Provider Business Mailing Address
First Line	:	4730 UNIVERSITY WAY NE STE 104
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	425-502-5699
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 UNIVERSITY WAY NE
Second Line	:	STE 104, #2332
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	425-502-5699
Fax Number	:

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

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	01/19/2024

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