Provider Demographics
NPI:1780964007
Name:STEPHENSON, TONEY WENDELL
Entity type:Individual
Prefix:MR
First Name:TONEY
Middle Name:WENDELL
Last Name:STEPHENSON
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 1:953 E SAHARA AVE STE B27
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3042
Mailing Address - Country:US
Mailing Address - Phone:702-204-0150
Mailing Address - Fax:024-622-5997
Practice Address - Street 1:953 E SAHARA AVE STE B27
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3042
Practice Address - Country:US
Practice Address - Phone:702-204-0150
Practice Address - Fax:024-622-5997
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17347101Y00000X
103K00000X, 106H00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist