Provider Demographics
NPI:1114125150
Name:STETSON, DAVID EARL (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EARL
Last Name:STETSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63833 O B RILEY RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8140
Mailing Address - Country:US
Mailing Address - Phone:541-771-2324
Mailing Address - Fax:
Practice Address - Street 1:63833 O B RILEY RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8140
Practice Address - Country:US
Practice Address - Phone:541-771-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130640Medicare PIN