| Doctor Name: | MR. MARK WAYNE STEVENS |
| NPI Number: | 1164681730 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, CSAC II |
| License Number: | 0794 |
| Business Practice Address: | 12166 Old Big Bend Rd Suite 100 Kirkwood, MO - 631226844 |
| Business Phone Number: | 3144526402 |
| Business Fax Number: | |
| Mailing Address: | 121 Pezold Dr, SAINT CHARLES |
| State: | MO |
| Postal Code: | 633047930 |
| Phone Number: | 3144526402 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2008 |
| NPI Last Update Date: | 06/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0794 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |