| Doctor Name: | MS. TERESA JO STUART |
| NPI Number: | 1255446498 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LSCSW, LCAC |
| License Number: | LCAC 186 |
| Business Practice Address: | 100 Military Ave Suite 116 Dodge City, KS - 678014946 |
| Business Phone Number: | 6203382168 |
| Business Fax Number: | 6202251311 |
| Mailing Address: | Po Box 602, BUCKLIN |
| State: | KS |
| Postal Code: | 678340602 |
| Phone Number: | 6203382168 |
| Fax Number: | 6202251311 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 04/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCAC 186 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |