Healthcare Provider Details

I. General information

NPI: 1649367707
Provider Name (Legal Business Name): STEPHEN C. WESTMORELAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SHILOH RD SUITE 801
TYLER TX
75703-2419
US

IV. Provider business mailing address

1810 SHILOH RD SUITE 801
TYLER TX
75703-2419
US

V. Phone/Fax

Practice location:
  • Phone: 903-593-8395
  • Fax: 903-581-8679
Mailing address:
  • Phone: 903-593-8395
  • Fax: 903-581-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21579
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN C WESTMORELAND
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 903-593-8395