MEDICARE: DR. THOMAS STENNIS BEARDEN 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	PSY 888	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000252676	OTHER	HI	HMSA PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659442218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS STENNIS BEARDEN PH.D.

Provider Business Mailing Address
First Line	:	101 AUPUNI ST
Second Line	:	SUITE 1014 A-2
City	:	HILO
State	:	HI
Zip	:	96720-4246
Country	:	US
Telephone Number	:	808-935-2605
Fax Number	:	808-935-2650

Provider Business Practice Location Address
First Line	:	101 AUPUNI ST
Second Line	:	SUITE 1014 A-2
City	:	HILO
State	:	HI
Zip	:	96720-4246
Country	:	US
Telephone Number	:	808-935-2605
Fax Number	:	808-935-2650

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/17/2011

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