Provider Demographics
NPI:1457371023
Name:STEVENS, JOELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOELLEN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N A ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4916
Mailing Address - Country:US
Mailing Address - Phone:805-487-2244
Mailing Address - Fax:805-487-2255
Practice Address - Street 1:410 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4916
Practice Address - Country:US
Practice Address - Phone:805-487-2244
Practice Address - Fax:805-487-2255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1490936Medicaid
CACP12171Medicare UPIN