Individual
MARY STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
7101 YORK AVE S, SUITE 161, EDINA, MN 55435-4450
(652) 921-9964
Mailing address
7101 YORK AVE S, SUITE 161, EDINA, MN 55435-4450
(652) 921-9964
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0970
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16890ST
BLUE CROSS
MN
05
—
476347500
—
MN
Enumeration date
04/20/2006
Last updated
12/03/2010
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