Judith G Tudiver, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

P0000002479 Issued in TN

Practice address

415 E Unaka Ave
Johnson City, TN 37601-4030

Phone

(423) 341-4752

Fax

(423) 283-0931

NPI assigned

May 24, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1316940182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3337 BONDWOOD CIR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376048904",
            "telephone_number": "423-341-4752",
            "fax_number": "423-283-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E UNAKA AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014030",
            "telephone_number": "423-341-4752",
            "fax_number": "423-283-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUDIVER",
        "first_name": "JUDITH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-24",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "TN",
            "license": "P0000002479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN MIS",
            "identifier": "540270000",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "229346",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS PIN-UNAKA ADDRESS",
            "identifier": "4065358",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3982954",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS TN PIN",
            "identifier": "4065358",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "7270161",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010300860",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trusted Benefits
• Joseph T Tucciarone Jr., PSYCHOLOGY INTERN
• Melissa Renee Tucker, LPC-MHSP, NCC
• William D. Tucker, MD
• Fraser G Tudiver, M.D.
• Dawn S Tuell, MD
• Laura Dawn Tugman, PHD
• Bailey Lynn Tullis, FNP
• Sheena L Tullock, FNP
• Dennis Turbyfill, RN

• Cognitive & Behavioral Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Cognitive & Behavioral Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.