MEDICARE: DR. STEVIE STANFORD 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	103T00000X	Psychologist	4305	AZ

General Provider Information

NPI Number	:	1750726667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVIE STANFORD PHD

Provider Business Mailing Address
First Line	:	3095 CORONADO TRAIL
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335
Country	:	US
Telephone Number	:	928-301-8392
Fax Number	:	928-567-1323

Provider Business Practice Location Address
First Line	:	3095 CORONADO TRAIL
Second Line	:
City	:	RIMROCK
State	:	AZ
Zip	:	86335
Country	:	US
Telephone Number	:	928-301-8392
Fax Number	:	928-567-1323

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/06/2013

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