Provider Demographics
NPI:1457698847
Name:STEVENSON, KOWANIS
Entity type:Individual
Prefix:MS
First Name:KOWANIS
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 GATSBY HOUSE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5116
Mailing Address - Country:US
Mailing Address - Phone:702-523-8179
Mailing Address - Fax:
Practice Address - Street 1:7636 GATSBY HOUSE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5116
Practice Address - Country:US
Practice Address - Phone:702-523-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst