Healthcare Provider Details

I. General information

NPI: 1366509929
Provider Name (Legal Business Name): JOHN T STEPHENSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24520 HAWTHORNE BLVD SUITE 220
TORRANCE CA
90505-6800
US

IV. Provider business mailing address

24520 HAWTHORNE BLVD SUITE 220
TORRANCE CA
90505-6800
US

V. Phone/Fax

Practice location:
  • Phone: 310-428-6708
  • Fax: 310-375-5262
Mailing address:
  • Phone: 310-428-6708
  • Fax: 310-375-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY16157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16157
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY16157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: