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General NPI Number Information
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NPI Number | 1043315609
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Entity Type | Individual
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Provider Name | TODD DOUGLAS EATON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 6110 SHALLOWFORD RD C O CRC
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1894
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Country | US
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Telephone | 800-632-6074
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Fax | 866-341-7509
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Provider Business Mailing Address
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Address Line | PO BOX 10414
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City | LARGO
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State | FL
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Zip | 33773-0414
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Country | US
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Telephone | 800-632-6074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3016
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P2021
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License Number State | TN
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