Provider Demographics
NPI:1245525500
Name:STEVENS, JR, FURTIS MARCEL
Entity type:Individual
Prefix:
First Name:FURTIS
Middle Name:MARCEL
Last Name:STEVENS, JR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FURTIS
Other - Middle Name:M
Other - Last Name:STEVENS, JR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT (R)
Mailing Address - Street 1:625 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2637
Mailing Address - Country:US
Mailing Address - Phone:608-280-2700
Mailing Address - Fax:
Practice Address - Street 1:625 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2637
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor