MEDICARE: VIVIAN M STEVENS PHD

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	103TC0700X	Clinical Psychologist	633	OK

General Provider Information

NPI Number	:	1245291012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN M STEVENS PHD

Provider Business Mailing Address
First Line	:	5310 E 31ST ST FL 13
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	918-561-5701
Fax Number	:	918-561-1173

Provider Business Practice Location Address
First Line	:	5310 E 31ST ST FL LL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	918-236-4000
Fax Number	:	918-236-4001

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	05/12/2021

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