Basic Information
| Provider Information | |||||||||
| NPI: | 1134327075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LCSW, CADCIII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 KAEN RD | ||||||||
| Address2: | SUITE 367 | ||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970454035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037425300 | ||||||||
| FaxNumber: | 5037425979 | ||||||||
| Practice Location | |||||||||
| Address1: | 11211 SE 82ND AVE | ||||||||
| Address2: | SUITE O | ||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037226200 | ||||||||
| FaxNumber: | 5037226545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 96-10-162 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | L4153 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.