Healthcare Provider Details

I. General information

NPI: 1083691604
Provider Name (Legal Business Name): TROY P TODD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

57950 LEAVENWORTH ST ATTN CREDENTIALS OFFICE
MCCONNELL AFB KS
67221-3506
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-3031
  • Fax:
Mailing address:
  • Phone: 316-759-5864
  • Fax: 316-759-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1310
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: