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NPI Code Detail

MEDICARE: MR. JAMES GILLESPIE STEVENSON CMHW

MEDICARE: MR. JAMES GILLESPIE STEVENSON CMHW
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
1101YM0800XMental Health CounselorCMHW-006WY

General Provider Information

NPI Number : 1376696781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES GILLESPIE STEVENSON CMHW
Provider Business Mailing Address
First Line : 2706 ANKENY WAY
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5649
Country : US
Telephone Number : 307-352-6689
Fax Number : 307-352-6692
Provider Business Practice Location Address
First Line : 2706 ANKENY WAY
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5649
Country : US
Telephone Number : 307-352-6689
Fax Number : 307-352-6692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 07/08/2007

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