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NPI 1689744302

NPI 1689744302 : EMILY STEWART STEVENS PSYD, MA : JACKSON, MI

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General NPI Number Information
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    NPI Number           |    1689744302
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    Entity Type          |    Individual 
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    Provider Name        |    EMILY STEWART STEVENS PSYD, MA
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    11/09/2006
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    Last Update Date     |    08/19/2025
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Provider Practice Location Address
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    Address Line         |    1201 E MICHIGAN AVE STE 200 
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    City                 |    JACKSON
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    State                |    MI
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    Zip                  |    49201-1855
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    Country              |    US
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    Telephone            |    517-204-4841
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    Fax                  |    517-205-5956
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Provider Business Mailing Address
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    Address Line         |    1 FORD PL STE 3A 
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    City                 |    DETROIT
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    State                |    MI
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    Zip                  |    48202-3450
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    Country              |    US
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    Telephone            |    313-744-8068
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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        |    103TC1900X
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    Taxonomy Name        |    Counseling Psychologist
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    License Number       |    6361004766
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    License Number State |    MI
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Taxonomy #2
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    Taxonomy Code        |    103TH0004X
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    Taxonomy Name        |    Health Psychologist
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    License Number       |    6351004721
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    License Number State |    MI
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Taxonomy #3
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    Taxonomy Code        |    103TC0700X
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    Taxonomy Name        |    Clinical Psychologist
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    License Number       |    6351004721
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    License Number State |    MI
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