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General NPI Number Information
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NPI Number | 1467476150
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Entity Type | Individual
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Provider Name | TEDD A STEPHENS EDD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2112 N ROAN ST FL 6
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2519
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Country | US
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Telephone | 423-928-1379
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Fax | 423-928-1379
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Provider Business Mailing Address
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Address Line | PO BOX 4644
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City | JOHNSON CITY
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State | TN
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Zip | 37602-4644
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Country | US
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Telephone | 423-928-1379
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Fax | 423-928-1379
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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 | P0000001029
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | CMT0000000186
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License Number State | TN
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