MEDICARE: MARION T STEVENS LPC

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	101YM0800X	Mental Health Counselor	4090-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992091441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARION T STEVENS LPC

Provider Business Mailing Address
First Line	:	1209 CHERRY AVE STE 202
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-1205
Country	:	US
Telephone Number	:	920-664-2490
Fax Number	:

Provider Business Practice Location Address
First Line	:	5109 WORLD DAIRY DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-3807
Country	:	US
Telephone Number	:	608-242-0220
Fax Number	:

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	07/21/2022

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