=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437227279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALERIE L STEPHENS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N KINNEY AVENUE
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-773-4836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N KINNEY AVENUE
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-773-4836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VALERIE L STEPHENS
-----------------------------------------------------
Credential | PHD PC
-----------------------------------------------------
Telephone | 989-773-4836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301007387
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------