Stephens, Tedd A

Stephens, Tedd A is an sole proprietor health care provider with primary practice located at 2112 N Roan St Fl 6 , Johnson City TN 37601-2519. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Stephens, Tedd A can be contacted via phone (423) 928-1379.

Contact Information

Primary practice address
2112 N Roan St Fl 6 Johnson City TN 37601-2519
Phone: (423) 928-1379
Fax: (423) 928-1379
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X P0000001029 Tennessee
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X CMT0000000186 Tennessee

Profile Details

NPI number 1467476150
LBN Legal business name Stephens, Tedd A
Credentials EDD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 26th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467476150 NPPES
Tennessee MEDICAID 3688713

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