Individual
MS. TEDRA STUART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3406 WATERMARK DR, SPRINGFIELD, OR 97477-6725
(503) 798-0706
Mailing address
3406 WATERMARK DR, SPRINGFIELD, OR 97477-6725
(503) 798-0706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1334
OR
101YP2500X
Professional Counselor
C1334
OR
253Z00000X
In Home Supportive Care Agency
Primary
859573
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
859573
—
OR
Enumeration date
09/26/2008
Last updated
09/22/2022
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