MEDICARE: MRS. RACHEL CORBAN STEWART 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	101YM0800X	Mental Health Counselor	MH 11840	FL

General Provider Information

NPI Number	:	1649552696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL CORBAN STEWART LMHC

Provider Business Mailing Address
First Line	:	2734 OAK RIDGE CT
Second Line	:	UNIT 404
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9369
Country	:	US
Telephone Number	:	239-910-0412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 OAK RIDGE CT
Second Line	:	UNIT 404
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9369
Country	:	US
Telephone Number	:	239-910-0412
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/16/2013

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