Provider Demographics
NPI:1861053548
Name:STEVENSON, CONNOR (LLP)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 E MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4207
Mailing Address - Country:US
Mailing Address - Phone:248-246-0172
Mailing Address - Fax:
Practice Address - Street 1:1861 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4207
Practice Address - Country:US
Practice Address - Phone:248-246-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361008184103T00000X
MI6362009517103TB0200X
156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist