Healthcare Provider Details

I. General information

NPI: 1790128577
Provider Name (Legal Business Name): DEBORAH SUSAN STEVENSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGH STREET SUITE 228
AUBURN CA
95603
US

IV. Provider business mailing address

19750 POPPY WAY
COLFAX CA
95713
US

V. Phone/Fax

Practice location:
  • Phone: 530-401-3537
  • Fax: 916-649-7158
Mailing address:
  • Phone: 530-401-3537
  • Fax: 916-649-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT91102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: