Provider Demographics
NPI:1902623143
Name:STEBBINS, MIRAH JOELLE
Entity type:Individual
Prefix:
First Name:MIRAH
Middle Name:JOELLE
Last Name:STEBBINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E GILCHRIST ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3707
Mailing Address - Country:US
Mailing Address - Phone:813-951-8053
Mailing Address - Fax:
Practice Address - Street 1:1001 E GILCHRIST ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3707
Practice Address - Country:US
Practice Address - Phone:813-951-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst