Healthcare Provider Details

I. General information

NPI: 1346575107
Provider Name (Legal Business Name): AMY STEVENSON LCPC,LADC,CCS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 SAWYER RD
SARASOTA FL
34233-1272
US

IV. Provider business mailing address

P.O. BOX 9478
BRADENTON FL
34206
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax: 941-782-4898
Mailing address:
  • Phone: 941-782-4299
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC2411
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCCS3580
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: