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General NPI Number Information
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NPI Number | 1740882497
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Entity Type | Individual
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Provider Name | STEVIE CHEYENNE MCFALL SUDC 1
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 11517 15TH AVE
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City | LEMOORE
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State | CA
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Zip | 93245-9508
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Country | US
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Telephone | 559-852-0416
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 E FLORINDA ST
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City | HANFORD
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State | CA
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Zip | 93230-3129
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Country | US
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Telephone | 559-852-0416
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11079
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License Number State | CA
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