MEDICARE: MR. TONEY WENDELL STEPHENSON

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	101Y00000X	Counselor	17347	NV
2	103K00000X	Behavior Analyst
3	106H00000X	Marriage & Family Therapist
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780964007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TONEY WENDELL STEPHENSON

Provider Business Mailing Address
First Line	:	953 E SAHARA AVE STE B27
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3042
Country	:	US
Telephone Number	:	702-204-0150
Fax Number	:	24-622-5997

Provider Business Practice Location Address
First Line	:	953 E SAHARA AVE STE B27
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3042
Country	:	US
Telephone Number	:	702-204-0150
Fax Number	:	24-622-5997

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	03/15/2024

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