MEDICARE: JESSICA ANN STEVENSON LMHC, LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2050	NH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2050	NH
3	101YM0800X	Mental Health Counselor	2050	NH

General Provider Information

NPI Number	:	1093187411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN STEVENSON LMHC, LCMHC

Provider Business Mailing Address
First Line	:	8 RICHARDSON RD
Second Line	:
City	:	NORTH CHELMSFORD
State	:	MA
Zip	:	01863-1915
Country	:	US
Telephone Number	:	603-421-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N COMMERCIAL ST STE 500
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1151
Country	:	US
Telephone Number	:	603-421-7123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2015
Last Update Date	:	02/27/2022

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