Provider Demographics
NPI:1508520230
Name:STEVENS, STEPHANIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26441 CROWN VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8529
Mailing Address - Country:US
Mailing Address - Phone:949-237-2609
Mailing Address - Fax:
Practice Address - Street 1:26441 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8528
Practice Address - Country:US
Practice Address - Phone:949-338-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32930103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist