Individual
MICHAEL L STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
109 N ARTHUR AVE STE 203, POCATELLO, ID 83204-3105
(208) 234-4673
(208) 234-4677
Mailing address
109 N ARTHUR AVE STE 203, POCATELLO, ID 83204-3105
(208) 234-4673
(208) 234-4677
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-1279
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807197600
—
ID
Enumeration date
09/16/2006
Last updated
12/10/2021
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