Provider Demographics
NPI:1144626920
Name:STEVENS, AMY (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1383
Mailing Address - Country:US
Mailing Address - Phone:417-396-3374
Mailing Address - Fax:
Practice Address - Street 1:512 E 32ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3920
Practice Address - Country:US
Practice Address - Phone:417-396-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT-LMSW 9437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker