Provider Demographics
NPI:1982634390
Name:STEVENS, LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5498
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5498
Mailing Address - Country:US
Mailing Address - Phone:318-422-7154
Mailing Address - Fax:850-203-1488
Practice Address - Street 1:1007 GOULD DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4971
Practice Address - Country:US
Practice Address - Phone:318-422-7154
Practice Address - Fax:850-203-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10120R2084P0800X
LA10160R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15-46377OtherUNITED BEHAVIORAL
MAZ58612OtherBLUE CROSS OF MASS
721351593001OtherHUMANA MILITARY
TX109294201OtherTEXAS MEDICAID
LA1980706Medicaid
005742285990OtherCIGNA
TX295065OtherTEXAS CHIP
LA1980706Medicaid
15-46377OtherUNITED BEHAVIORAL
005742285990OtherCIGNA