Provider Demographics
NPI:1740882497
Name:MCFALL, STEVIE CHEYENNE (SUDC 1)
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:CHEYENNE
Last Name:MCFALL
Suffix:
Gender:F
Credentials:SUDC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E FLORINDA ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3129
Mailing Address - Country:US
Mailing Address - Phone:559-852-0416
Mailing Address - Fax:
Practice Address - Street 1:11517 15TH AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9508
Practice Address - Country:US
Practice Address - Phone:559-852-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA11079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator