Provider Demographics
NPI:1104337310
Name:STEVENS, MICHELLE CAMILE (PHD, LPC- MHSP)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CAMILE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD, LPC- MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 EMERY CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-6700
Mailing Address - Country:US
Mailing Address - Phone:615-956-8347
Mailing Address - Fax:
Practice Address - Street 1:431 NISSAN DR STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4365
Practice Address - Country:US
Practice Address - Phone:615-956-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health