Provider Demographics
NPI:1750726667
Name:STANFORD, STEVIE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVIE
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 CORONADO TRAIL
Mailing Address - Street 2:
Mailing Address - City:RIMROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86335
Mailing Address - Country:US
Mailing Address - Phone:928-301-8392
Mailing Address - Fax:928-567-1323
Practice Address - Street 1:3095 CORONADO TRAIL
Practice Address - Street 2:
Practice Address - City:RIMROCK
Practice Address - State:AZ
Practice Address - Zip Code:86335
Practice Address - Country:US
Practice Address - Phone:928-301-8392
Practice Address - Fax:928-567-1323
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist