Provider Demographics
NPI:1699907154
Name:STEWART, PEG (LPC 1872)
Entity type:Individual
Prefix:
First Name:PEG
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPC 1872
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2014
Mailing Address - Country:US
Mailing Address - Phone:602-409-0671
Mailing Address - Fax:
Practice Address - Street 1:1540 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1448
Practice Address - Country:US
Practice Address - Phone:602-409-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1891101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor