Basic Information
| Provider Information | |||||||||
| NPI: | 1497992978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | LORIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 CABRILLO HWY S | ||||||||
| Address2: | |||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940198200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503723243 | ||||||||
| FaxNumber: | 6507264963 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CABRILLO HWY S | ||||||||
| Address2: | |||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940198200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503723243 | ||||||||
| FaxNumber: | 6507264963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 01/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 54757 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.