Provider Demographics
NPI:1003121021
Name:STEPHENSON, CHRISTIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 12TH AVE RD
Mailing Address - Street 2:143
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6300
Mailing Address - Country:US
Mailing Address - Phone:208-703-9771
Mailing Address - Fax:208-247-4312
Practice Address - Street 1:847 PARKCENTRE WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1792
Practice Address - Country:US
Practice Address - Phone:208-703-9771
Practice Address - Fax:208-247-4312
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health