Basic Information
| Provider Information | |||||||||
| NPI: | 1639635428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | VIERRE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 21000 PLUMMER ST | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913114903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188826400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21000 PLUMMER ST | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913114903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188826400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2019 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | CA | N | Behavioral Health & Social Service Providers | Social Worker | 225400000X | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 1041C0700X | 111391 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.