Doctor Name: | DR. TERESA STEVENSON |
NPI Number: | 1629414735 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY13847 |
Business Practice Address: | 4001 California Highway 104 Ione, CA - 95640 |
Business Phone Number: | 2092744911 |
Business Fax Number: | |
Mailing Address: | 9102 Generations Dr, ELK GROVE |
State: | CA |
Postal Code: | 957581202 |
Phone Number: | 3109039620 |
Fax Number: | |
NPI Enumeration Date: | 05/15/2013 |
NPI Last Update Date: | 07/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY13847 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |