Provider Demographics
NPI:1801014428
Name:STEVENS, SAM J (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SE MORRISON ST
Mailing Address - Street 2:STE. 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2327
Mailing Address - Country:US
Mailing Address - Phone:503-957-8797
Mailing Address - Fax:503-546-0120
Practice Address - Street 1:516 SE MORRISON ST
Practice Address - Street 2:STE. 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2327
Practice Address - Country:US
Practice Address - Phone:503-957-8797
Practice Address - Fax:503-546-0120
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057211106H00000X
ORTO605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist