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General NPI Number Information
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NPI Number | 1265500615
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Entity Type | Organization
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Legal Business Name | DR TEDD STEPHENS EDD
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2112 N ROAN ST 6TH FL
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City | JOHNSON CITY
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State | TN
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Zip | 37601
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Country | US
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Telephone | 423-928-1379
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 N ROAN ST 6TH FL
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City | JOHNSON CITY
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State | TN
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Zip | 37601
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Country | US
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Telephone | 423-928-1379
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | DR. TEDD STEPHENS
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Credential | EDD
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Telephone | 423-928-1379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | TN
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