Provider Demographics
NPI:1568644169
Name:STEVENS, NEILE (LAC)
Entity Type:Individual
Prefix:
First Name:NEILE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7416
Mailing Address - Country:US
Mailing Address - Phone:870-793-6774
Mailing Address - Fax:870-793-1997
Practice Address - Street 1:2199 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7416
Practice Address - Country:US
Practice Address - Phone:870-793-6774
Practice Address - Fax:870-793-1997
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1803020101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232855795Medicaid