Provider Demographics
NPI:1164844924
Name:STEPHENS, MICHAEL (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1741
Mailing Address - Country:US
Mailing Address - Phone:916-729-3098
Mailing Address - Fax:916-729-3006
Practice Address - Street 1:7600 N INGRAM AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5824
Practice Address - Country:US
Practice Address - Phone:916-729-3098
Practice Address - Fax:916-729-3006
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12689103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst