Provider Demographics
NPI:1902262397
Name:STEVENS, TAMMY LYNN (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1065
Mailing Address - Country:US
Mailing Address - Phone:859-972-0045
Mailing Address - Fax:
Practice Address - Street 1:1589 HILL RISE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-977-2508
Practice Address - Fax:859-223-9231
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240098101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)