Provider Demographics
NPI:1932486891
Name:STEVENS, TERRELL MARK (BS)
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:MARK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:541-956-5463
Practice Address - Street 1:1920 SW KURTZ LANE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2804
Practice Address - Country:US
Practice Address - Phone:541-295-3072
Practice Address - Fax:541-295-3074
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health