Provider Demographics
NPI:1215914304
Name:TOWNSEND, STEVEN GLEN (EDD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GLEN
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-6420
Mailing Address - Country:US
Mailing Address - Phone:269-323-9797
Mailing Address - Fax:269-323-7779
Practice Address - Street 1:8928 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-6420
Practice Address - Country:US
Practice Address - Phone:269-323-9797
Practice Address - Fax:269-323-7779
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C946040OtherBLUE CROSS/BLUE SHIELD
MI680C946040OtherBLUE CROSS/BLUE SHIELD