Provider Demographics
NPI:1053575753
Name:STEVENS, MADELEINE NOEL (LPCC, LPAT)
Entity type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:NOEL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAMINO DE SAN FELIPE
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9388
Mailing Address - Country:US
Mailing Address - Phone:505-867-2383
Mailing Address - Fax:505-867-7293
Practice Address - Street 1:301 CAMINO DEL PUEBLO
Practice Address - Street 2:VALLE DEL SOL
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-867-2383
Practice Address - Fax:505-867-7273
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0121691101YP2500X
NMT-0112361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health