MEDICARE: MARILYN STEVENS LCSW

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
1	101YM0800X	Mental Health Counselor	149001214

General Provider Information

NPI Number	:	1043221484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN STEVENS LCSW

Provider Business Mailing Address
First Line	:	363 SOUTH MAIN STREET
Second Line	:	SUITE 220
City	:	DECATUR
State	:	IL
Zip	:	62523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 S MAIN ST
Second Line	:	SUITE 220
City	:	DECATUR
State	:	IL
Zip	:	62523-1417
Country	:	US
Telephone Number	:	217-638-5545
Fax Number	:	217-424-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/14/2012

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Directions to “ MARILYN STEVENS LCSW” Practice Location

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