Provider Demographics
NPI:1972302883
Name:STEVENSON, BRENDAN ALEXANDER
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:ALEXANDER
Last Name:STEVENSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LYNNE
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 GA-34
Practice Address - Street 2:BUILDING 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:470-394-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician