Mack B. Stephenson, PH.D., CHTD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-202056 Issued in ID

Legal business name

MACK B. STEPHENSON, PH.D., CHTD

Practice address

78 SW 5TH Ave
Suite 2
Meridian, ID 83642-2923

Phone

(208) 288-0692

Fax

(208) 288-0467

NPI assigned

Jan 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mack B. Stephenson, PH.D.NPI 1467676254

Title

President

Phone

(208) 288-0692

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mack B. Stephenson, PH.D.

  • Psychologist
  • Meridian, ID
  • NPI 1467676254
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093860561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 SW 5TH AVE",
            "address_2": "SUITE 2",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422923",
            "telephone_number": "208-288-0692",
            "fax_number": "208-288-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 SW 5TH AVE",
            "address_2": "SUITE 2",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422923",
            "telephone_number": "208-288-0692",
            "fax_number": "208-288-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACK B. STEPHENSON, PH.D., CHTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "MACK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-288-0692",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-202056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Tyler Lytle, DMD
• Vanessa Macdonagh, CSFA
• Katrina Larene Mace
• Rebecca Mace
• Julie Macgregor, PA-C, LE
• Mark Macumber, MD
• Kathryn Maddux, PA-C
• Joseph Maggio, DPT
• Claire Magnolo, PA-C
• Jonathan Eric Main, DC

• Psychologist in Meridian, ID
• Providers in Meridian, ID by specialty
• Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.