Provider Demographics
NPI:1912303454
Name:STEWARD, PATRICK (MAC,III)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:STEWARD
Suffix:
Gender:M
Credentials:MAC,III
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:STEWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC,III
Mailing Address - Street 1:1 LAKESHORE DR STE 1640E
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70629-0100
Mailing Address - Country:US
Mailing Address - Phone:337-794-5351
Mailing Address - Fax:337-433-4894
Practice Address - Street 1:1 LAKESHORE DR STE 1640E
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0100
Practice Address - Country:US
Practice Address - Phone:337-794-5351
Practice Address - Fax:337-433-4894
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63703101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)