Active NPI
Theodore L Baldick, PH.D.
- Clinical Psychologist
- Memphis, TN
National Provider Identifier
1497755979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P0000000685
- Practice address
- 3950 Central Ave
Memphis, TN 38111-7602 - Phone
- (901) 458-6291
- Fax
- (901) 323-4848
- NPI assigned
- Jul 27, 2005
- Last updated
- Feb 4, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 27365 | MS | |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | P0000000685 | TN | |
| Clinical Psychologist | 103TC0700X | P0000000685 | TN | Primary |
| Group Psychotherapy Psychologist | 103TP2701X | P0000000685 | TN |
Addresses
Primary practice location
3950 Central Ave
Memphis, TN 38111-7602
Mailing address
3950 Central Ave
Memphis, TN 38111-7602
Phone (901) 458-6291
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009713 | Other | TN | TN BLUE SHIELD |
| 2033550 | Other | TN | CIGNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27365 | MS | MD | Psychologist |
| P0000000685 | TN | MD | Addiction (Substance Use Disorder) Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202083200000",
"number": "1497755979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3950 CENTRAL AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381117602",
"telephone_number": "901-458-6291",
"fax_number": "901-323-4848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 CENTRAL AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381117602",
"telephone_number": "901-458-6291",
"fax_number": "901-323-4848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALDICK",
"first_name": "THEODORE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-27",
"last_updated": "2008-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MS",
"license": "27365",
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "TN",
"license": "P0000000685",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P0000000685",
"primary": true
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "TN",
"license": "P0000000685",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN BLUE SHIELD",
"identifier": "0009713",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2033550",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.