Healthcare Provider Details

I. General information

NPI: 1629301429
Provider Name (Legal Business Name): DAVID JEFFREY STEPHENS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

402 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907-4218
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-9590
  • Fax:
Mailing address:
  • Phone: 719-571-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2411
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number482
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: