Provider Demographics
NPI:1265743165
Name:CURTIS, STEPHEN (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 E INVERNESS WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9192
Mailing Address - Country:US
Mailing Address - Phone:812-327-0932
Mailing Address - Fax:
Practice Address - Street 1:205 N COLLEGE AVE
Practice Address - Street 2:SUITE 713
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3950
Practice Address - Country:US
Practice Address - Phone:812-333-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040021A103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20040021AOtherLICENSE NUMBER