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General NPI Number Information
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NPI Number | 1235463597
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Entity Type | Individual
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Provider Name | RANDI MARIE STEVENS M.ED, LPC, CRC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 1621 N 3RD ST STE 1100
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3381
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Country | US
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Telephone | 208-625-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 W GRANGE AVE
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City | POST FALLS
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State | ID
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Zip | 83854-8554
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Country | US
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Telephone | 208-625-1343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-4085
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00108377
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License Number State | ID
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