Provider Demographics
NPI:1275084634
Name:CONYERS, STEVEN ANTHONY (MA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:CONYERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CHAPIN AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2032
Mailing Address - Country:US
Mailing Address - Phone:248-835-5985
Mailing Address - Fax:
Practice Address - Street 1:655 CHAPIN AVENUE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-2032
Practice Address - Country:US
Practice Address - Phone:248-835-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist