Healthcare Provider Details

I. General information

NPI: 1457371023
Provider Name (Legal Business Name): JOELLEN STEVENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N A ST
OXNARD CA
93030-4916
US

IV. Provider business mailing address

410 N A ST
OXNARD CA
93030-4916
US

V. Phone/Fax

Practice location:
  • Phone: 805-487-2244
  • Fax: 805-487-2255
Mailing address:
  • Phone: 805-487-2244
  • Fax: 805-487-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: