Provider Demographics
NPI:1154618627
Name:STEVENS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 MELODY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4124
Mailing Address - Country:US
Mailing Address - Phone:303-491-1981
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DR STE 101
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4124
Practice Address - Country:US
Practice Address - Phone:303-491-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9051101YP2500X
COLPC.0019971101YM0800X, 101YP2500X
WYLPC-2215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional