Provider Demographics
NPI:1689744302
Name:STEWART STEVENS, EMILY (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:STEWART STEVENS
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8469 E STURTEVANT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8543
Mailing Address - Country:US
Mailing Address - Phone:269-806-9571
Mailing Address - Fax:
Practice Address - Street 1:7920 KIRKLAND CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-345-0669
Practice Address - Fax:269-345-5354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004721103TC0700X, 103TH0004X
MI6361004766103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling