Provider Demographics
NPI:1366033516
Name:STEVENS, SAVANNAH JO (BCBA)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JO
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 OLIVE STREET
Mailing Address - Street 2:
Mailing Address - City:SHREVEPRT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-300-3560
Mailing Address - Fax:318-300-3561
Practice Address - Street 1:925 OLIVE STREET
Practice Address - Street 2:
Practice Address - City:SHREVEPRT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-300-3560
Practice Address - Fax:318-300-3561
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-501103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst