Provider Demographics
NPI:1679605695
Name:STEVENS, MICHAEL VARGO (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VARGO
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1812
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1839
Mailing Address - Country:US
Mailing Address - Phone:541-806-7997
Mailing Address - Fax:
Practice Address - Street 1:704 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1720
Practice Address - Country:US
Practice Address - Phone:541-806-7997
Practice Address - Fax:541-387-2553
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101635Medicare ID - Type Unspecified