Healthcare Provider Details

I. General information

NPI: 1174105811
Provider Name (Legal Business Name): HEIDI STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD STE 145
WEST BLOOMFIELD MI
48322-4471
US

IV. Provider business mailing address

1739 W BIG BEAVER RD
TROY MI
48084-3510
US

V. Phone/Fax

Practice location:
  • Phone: 248-957-1860
  • Fax:
Mailing address:
  • Phone: 248-957-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: