Provider Demographics
NPI:1770833600
Name:STEVENSON, EVON DENISE
Entity Type:Individual
Prefix:MS
First Name:EVON
Middle Name:DENISE
Last Name:STEVENSON
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 1:4045 S BUFFALO DR # A101-294
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7479
Mailing Address - Country:US
Mailing Address - Phone:702-326-4438
Mailing Address - Fax:702-473-5332
Practice Address - Street 1:4055 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-9303
Practice Address - Country:US
Practice Address - Phone:702-799-9710
Practice Address - Fax:702-799-9712
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner