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NPI Code Detail

MEDICARE: TEDD A STEPHENS EDD

MEDICARE: TEDD A STEPHENS EDD
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
1103TC0700XClinical PsychologistP0000001029TN
2103TC2200XClinical Child & Adolescent PsychologistCMT0000000186TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467476150
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEDD A STEPHENS EDD
Provider Business Mailing Address
First Line : PO BOX 4644
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37602-4644
Country : US
Telephone Number : 423-928-1379
Fax Number : 423-928-1379
Provider Business Practice Location Address
First Line : 2112 N ROAN ST FL 6
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-2519
Country : US
Telephone Number : 423-928-1379
Fax Number : 423-928-1379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 09/11/2025

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Directions to “ TEDD A STEPHENS EDD” Practice Location

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