Provider Demographics
NPI:1174381164
Name:STROUD, STEVEN SHANE II (LLC BUSINESS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:SHANE
Last Name:STROUD
Suffix:II
Gender:M
Credentials:LLC BUSINESS
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:SHANE
Other - Last Name:STROUD
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:QUARANTINE HEALTH
Mailing Address - Street 1:500 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2438
Mailing Address - Country:US
Mailing Address - Phone:812-902-4994
Mailing Address - Fax:
Practice Address - Street 1:500 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2438
Practice Address - Country:US
Practice Address - Phone:812-902-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN$$$$$$$$$103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty