Provider Demographics
NPI:1043058936
Name:STEVENSON, NIEM
Entity type:Individual
Prefix:MR
First Name:NIEM
Middle Name:
Last Name:STEVENSON
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 1:3939 US HIGHWAY 80 E STE 223
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3353
Mailing Address - Country:US
Mailing Address - Phone:972-373-4932
Mailing Address - Fax:
Practice Address - Street 1:3939 US HIGHWAY 80 E STE 223
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3353
Practice Address - Country:US
Practice Address - Phone:972-373-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health