MEDICARE: DR. MICHELLE CAMILE STEVENS PH.D., LPC- MHSP

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	4047	TN

General Provider Information

NPI Number	:	1104337310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE CAMILE STEVENS PH.D., LPC- MHSP

Provider Business Mailing Address
First Line	:	3401 EMERY CT
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-6700
Country	:	US
Telephone Number	:	615-956-8347
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 NISSAN DR STE 200
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:	615-956-8347
Fax Number	:

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

Provider Enumeration Date	:	10/14/2017
Last Update Date	:	10/14/2017

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