MEDICARE: STEPHEN BRAUN TUELLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	334	SD

General Provider Information

NPI Number	:	1154425767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN BRAUN TUELLER PH.D.

Provider Business Mailing Address
First Line	:	1920 N 2050 E
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84040-2300
Country	:	US
Telephone Number	:	801-593-6179
Fax Number	:

Provider Business Practice Location Address
First Line	:	7309 11TH ST BLDG 545
Second Line	:
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-7909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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