MEDICARE: TINA MARIE STEVENS

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1972316446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA MARIE STEVENS

Provider Business Mailing Address
First Line	:	125 COLUMBUS AVE NW APT 4
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4754
Country	:	US
Telephone Number	:	330-605-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 COLUMBUS AVE NW APT 4
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4754
Country	:	US
Telephone Number	:	330-605-2092
Fax Number	:

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

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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Directions to “ TINA MARIE STEVENS ” Practice Location

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