=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982634390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE STEVENS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 09/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 GOULD DR STE 1
-----------------------------------------------------
City | BOSSIER CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71111-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-422-7154
-----------------------------------------------------
Fax | 850-203-1448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5498
-----------------------------------------------------
City | BOSSIER CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71171-5498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-422-7154
-----------------------------------------------------
Fax | 850-203-1488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 10120R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 10160R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------