Provider Demographics
NPI:1720614464
Name:BENT, STEVENS BAKER
Entity Type:Individual
Prefix:
First Name:STEVENS
Middle Name:BAKER
Last Name:BENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 AMY WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-8606
Mailing Address - Country:US
Mailing Address - Phone:970-759-1137
Mailing Address - Fax:
Practice Address - Street 1:424 AMY WAY
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-8606
Practice Address - Country:US
Practice Address - Phone:970-759-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health