Provider Demographics
NPI:1083224281
Name:STEWART, CELENA (MA,)
Entity type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 LOUETTA RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4271
Mailing Address - Country:US
Mailing Address - Phone:773-620-3786
Mailing Address - Fax:
Practice Address - Street 1:2011 LOUETTA RESERVE WAY
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4271
Practice Address - Country:US
Practice Address - Phone:773-620-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty