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General NPI Number Information
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NPI Number | 1285757013
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Entity Type | Individual
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Provider Name | MARK THEODORE SIMPSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 119 BOONE RIDGE DR SUITE 201
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City | JOHNSON CITY
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State | TN
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Zip | 37615
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Country | US
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Telephone | 865-673-6741
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Fax | 865-673-6634
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Provider Business Mailing Address
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Address Line | 310 25TH AVE N STE 204
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City | NASHVILLE
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State | TN
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Zip | 37203-2492
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Country | US
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Telephone | 615-385-4090
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Fax | 615-385-0138
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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 | 3205
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License Number State | TN
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