Basic Information
| Provider Information | |||||||||
| NPI: | 1578942751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVERSON | ||||||||
| FirstName: | KIEISHA | ||||||||
| MiddleName: | TONIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 H ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615466365 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2821 H ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615466365 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2015 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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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 | IMF 79932 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.