Dr Tedd Stephens Edd

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

DR TEDD STEPHENS EDD

Practice address

2112 N Roan St
6TH FL
Johnson City, TN 37601

Phone

(423) 928-1379

NPI assigned

Dec 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tedd Stephens, EDDNPI 1467476150

Title

Owener

Phone

(423) 928-1379

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Tedd A Stephens, EDD

  • Clinical Child & Adolescent Psychologist
  • Johnson City, TN
  • NPI 1467476150
  NPD (past) Authorized official

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

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265500615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 N ROAN ST",
            "address_2": "6TH FL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-928-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 N ROAN ST",
            "address_2": "6TH FL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-928-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR TEDD STEPHENS EDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "TEDD",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "423-928-1379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3688713",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychologist in Tennessee

• 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.