Provider Demographics
NPI:1396273777
Name:STEVENS, JOSHUA (MCP, LPC-CANDIDATE)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MCP, LPC-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3842
Mailing Address - Country:US
Mailing Address - Phone:580-233-8900
Mailing Address - Fax:580-540-9819
Practice Address - Street 1:516 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3842
Practice Address - Country:US
Practice Address - Phone:580-233-8900
Practice Address - Fax:580-540-9819
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health