Healthcare Provider Details

I. General information

NPI: 1760607170
Provider Name (Legal Business Name): DENNIS EARL STEVENS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 HEYWARD CT
EAGLE MOUNTAIN UT
84043-5283
US

IV. Provider business mailing address

3345 E. HEYWARD CT.
EAGLE MOUNTAIN UT
84005
US

V. Phone/Fax

Practice location:
  • Phone: 801-789-8245
  • Fax:
Mailing address:
  • Phone: 801-789-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120662-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: