Healthcare Provider Details

I. General information

NPI: 1497290373
Provider Name (Legal Business Name): HEATHER BREANNE STEVENS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNE STEVENS MS

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 S US HIGHWAY 41 GIBAULT CARE, INC.
TERRE HAUTE IN
47802-4749
US

IV. Provider business mailing address

890 JOHNNIE DODDS BLVD UNIT 3
MOUNT PLEASANT SC
29464-6129
US

V. Phone/Fax

Practice location:
  • Phone: 812-299-1156
  • Fax: 812-299-0118
Mailing address:
  • Phone: 843-884-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8142
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: