MEDICARE: JOHN H STUHL

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	103TC1900X	Counseling Psychologist	P000002053	TN
2	103TB0200X	Cognitive & Behavioral Psychologist	P0000002053	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3044251	OTHER	TN	BC/BS OF TN

General Provider Information

NPI Number	:	1770591323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H STUHL

Provider Business Mailing Address
First Line	:	PO BOX 1694
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-1694
Country	:	US
Telephone Number	:	864-947-9113
Fax Number	:	865-947-9146

Provider Business Practice Location Address
First Line	:	109 STEKOIA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-1608
Country	:	US
Telephone Number	:	865-947-9113
Fax Number	:	865-675-4853

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/20/2010

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Directions to “ JOHN H STUHL ” Practice Location

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