Healthcare Provider Details

I. General information

NPI: 1184830143
Provider Name (Legal Business Name): TOBY S ALTFELD SPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 C WEST UNIVERSITY PARKWAY
JACKSON TN
38305
US

IV. Provider business mailing address

71 SOUTHWIND DR
JACKSON TN
38305-3963
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-0749
  • Fax: 731-512-3875
Mailing address:
  • Phone: 731-394-0749
  • Fax: 731-512-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPE0000000388
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: