Provider Demographics
NPI:1811275118
Name:STEVENS, NICOLE K (BCBA, LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BCBA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5220
Mailing Address - Country:US
Mailing Address - Phone:801-255-5131
Mailing Address - Fax:801-255-5131
Practice Address - Street 1:1870 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7741
Practice Address - Country:US
Practice Address - Phone:801-255-5131
Practice Address - Fax:801-255-5131
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8588423-2506103K00000X
UT0-11-4007103K00000X
UT8588423-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst