Healthcare Provider Details

I. General information

NPI: 1740882497
Provider Name (Legal Business Name): STEVIE CHEYENNE MCFALL SUDC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 15TH AVE
LEMOORE CA
93245-9508
US

IV. Provider business mailing address

1005 E FLORINDA ST
HANFORD CA
93230-3129
US

V. Phone/Fax

Practice location:
  • Phone: 559-852-0416
  • Fax:
Mailing address:
  • Phone: 559-852-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: