Doctor Name: | MRS. JESSICA CAROL STEVENS |
NPI Number: | 1003240110 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPN |
License Number: | |
Business Practice Address: | 70 N 31st St Clinton, OK - 736019116 |
Business Phone Number: | 5803236021 |
Business Fax Number: | |
Mailing Address: | 70 N 31st St, CLINTON |
State: | OK |
Postal Code: | 736019116 |
Phone Number: | 5803236021 |
Fax Number: | 5803235635 |
NPI Enumeration Date: | 08/26/2013 |
NPI Last Update Date: | 08/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |