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General NPI Number Information
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NPI Number | 1972082006
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Entity Type | Individual
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Provider Name | ASHLEY RENEE STEVENSON
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Gender | Female
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 2344 FLOSSMOOR RD
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1614
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Country | US
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Telephone | 310-800-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 600 ALAMEDA STREET EAST
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City | COMPTON
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State | CA
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Zip | 90221
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.000901
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License Number State | IL
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