Healthcare Provider Details

I. General information

NPI: 1306181029
Provider Name (Legal Business Name): ZACKERY ALEXANDER TEDDER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 N MOPAC EXPY STE 901
AUSTIN TX
78759-8348
US

IV. Provider business mailing address

8500 N MOPAC EXPY STE 901
AUSTIN TX
78759-8348
US

V. Phone/Fax

Practice location:
  • Phone: 512-200-2516
  • Fax:
Mailing address:
  • Phone: 512-710-5809
  • Fax: 737-241-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36417
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: