Provider Demographics
NPI:1558183921
Name:STEVENSON, BAILEY (LMSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12117 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-8521
Mailing Address - Country:US
Mailing Address - Phone:318-393-9761
Mailing Address - Fax:
Practice Address - Street 1:800 SPRING ST STE 205
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3757
Practice Address - Country:US
Practice Address - Phone:318-670-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker