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NPI Code Detail

MEDICARE: KEITH STEPHENS

MEDICARE: KEITH STEPHENS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorR1536801123CA

General Provider Information

NPI Number : 1043068679
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH STEPHENS
Provider Business Mailing Address
First Line : 1100 N D ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3524
Country : US
Telephone Number : 909-884-0840
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N D ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3524
Country : US
Telephone Number : 909-884-0840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 04/28/2026

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Directions to “ KEITH STEPHENS ” Practice Location

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