Provider Demographics
NPI:1750159190
Name:STEVENS, SARAH (CPSS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2493
Mailing Address - Country:US
Mailing Address - Phone:606-305-6678
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-485-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1212595251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health