Provider Demographics
NPI:1104463421
Name:STEWART, LASHON TYRICE
Entity type:Individual
Prefix:MR
First Name:LASHON
Middle Name:TYRICE
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W. CAMELBACK RD
Mailing Address - Street 2:STE A#723
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-5265
Mailing Address - Country:US
Mailing Address - Phone:602-565-8096
Mailing Address - Fax:
Practice Address - Street 1:24 W. CAMELBACK RD
Practice Address - Street 2:STE A#723
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-5265
Practice Address - Country:US
Practice Address - Phone:602-565-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor