Provider Demographics
NPI:1639474018
Name:STEVENS, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22461 I 30
Mailing Address - Street 2:BUILDING 1000
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2364
Mailing Address - Country:US
Mailing Address - Phone:501-847-0081
Mailing Address - Fax:501-847-6905
Practice Address - Street 1:22461 I 30
Practice Address - Street 2:BUILDING 1000
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2364
Practice Address - Country:US
Practice Address - Phone:501-847-0081
Practice Address - Fax:501-847-6905
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst