Provider Demographics
NPI:1023760113
Name:STEPHENS, CALEB ASHLEY
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:ASHLEY
Last Name:STEPHENS
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 1:609 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4205
Mailing Address - Country:US
Mailing Address - Phone:248-672-0437
Mailing Address - Fax:
Practice Address - Street 1:609 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-4205
Practice Address - Country:US
Practice Address - Phone:248-672-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator