Provider Demographics
NPI:1801172986
Name:STEVENS, DARYL ARNOLD (BA,)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:ARNOLD
Last Name:STEVENS
Suffix:
Gender:M
Credentials:BA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 10TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-255-1813
Mailing Address - Fax:320-202-9997
Practice Address - Street 1:832 10TH AVE N
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2256
Practice Address - Country:US
Practice Address - Phone:320-255-1813
Practice Address - Fax:320-202-9997
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)