MEDICARE: MS. SHAWNA KAY STEWART

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	10629	TX
2	101YP2500X	Professional Counselor	10629	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1689872392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAWNA KAY STEWART

Provider Business Mailing Address
First Line	:	6412 WILTON DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5135
Country	:	US
Telephone Number	:	682-597-4126
Fax Number	:	817-916-4665

Provider Business Practice Location Address
First Line	:	400 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-7010
Country	:	US
Telephone Number	:	817-335-1994
Fax Number	:	817-916-4665

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	01/06/2022

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