Basic Information
| Provider Information | |||||||||
| NPI: | 1255727657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | MIKESHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6711 ARLINGTON AVE STE D | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925041966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517426380 | ||||||||
| FaxNumber: | 9516371577 | ||||||||
| Practice Location | |||||||||
| Address1: | 6711 ARLINGTON AVE STE D | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925041966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517426380 | ||||||||
| FaxNumber: | 9516371577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.