Provider Demographics
NPI:1619019890
Name:STEVENSON, JEANA M (EDD)
Entity type:Individual
Prefix:DR
First Name:JEANA
Middle Name:M
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4869 ASHCROFT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4389
Mailing Address - Country:US
Mailing Address - Phone:901-849-0488
Mailing Address - Fax:
Practice Address - Street 1:7051 HIGHWAY 70 S STE 103
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2207
Practice Address - Country:US
Practice Address - Phone:615-298-5573
Practice Address - Fax:615-298-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN2545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health