Provider Demographics
NPI:1093085557
Name:STEVENSON, CLARISSA S (MED)
Entity type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:S
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 DEL PORTE DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4322
Mailing Address - Country:US
Mailing Address - Phone:405-619-7069
Mailing Address - Fax:
Practice Address - Street 1:4716 DEL PORTE DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4322
Practice Address - Country:US
Practice Address - Phone:405-619-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst