Healthcare Provider Details

I. General information

NPI: 1518425305
Provider Name (Legal Business Name): BRUCE B. STEVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 NEBRASKA AVE
TOLEDO OH
43607-4222
US

IV. Provider business mailing address

2005 ASHLAND AVE
TOLEDO OH
43620-1703
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-7701
  • Fax: 419-255-4037
Mailing address:
  • Phone: 419-841-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: