Provider Demographics
NPI:1710022603
Name:STEVENS, JIMMY LEE (MS)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:LEE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 NICHOLASVILLE RD
Mailing Address - Street 2:400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1429
Mailing Address - Country:US
Mailing Address - Phone:859-276-5285
Mailing Address - Fax:859-277-3513
Practice Address - Street 1:1517 NICHOLASVILLE RD
Practice Address - Street 2:400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1429
Practice Address - Country:US
Practice Address - Phone:859-276-5285
Practice Address - Fax:859-277-3513
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical