Provider Demographics
NPI:1942577549
Name:STEVENS, ANGELA ERVIN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ERVIN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 N GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4055
Mailing Address - Country:US
Mailing Address - Phone:901-683-8787
Mailing Address - Fax:
Practice Address - Street 1:4738 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-2524
Practice Address - Country:US
Practice Address - Phone:901-288-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23-74128932080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics