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General NPI Number Information
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NPI Number | 1982978193
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Entity Type | Organization
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Legal Business Name | GUY L TEWKSBURY, PH.D. PA
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 11590 SEMINOLE BLVD
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City | LARGO
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State | FL
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Zip | 33778-3204
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Country | US
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Telephone | 727-375-5924
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Fax |
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Provider Business Mailing Address
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Address Line | 50 8TH AVE SW # 2006
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City | LARGO
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State | FL
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Zip | 33770-3638
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Country | US
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Telephone | 727-375-5924
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUY L TEWKSBURY
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Credential | PH.D PA
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Telephone | 727-375-5924
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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 | PY4179
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License Number State | FL
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