Provider Demographics
NPI:1477734564
Name:STEVENS, JOHN LESLIE (LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5727
Mailing Address - Country:US
Mailing Address - Phone:601-940-3870
Mailing Address - Fax:
Practice Address - Street 1:150 FOUNTAINS BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6377
Practice Address - Country:US
Practice Address - Phone:601-898-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health