Individual provider Active NPI

Edward Hugh Tenison III, PH.D.

  • Clinical Psychologist
  • Roanoke, VA
National Provider Identifier
1780604470
Registry record updated Jan 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810002134 Issued in VA
Practice address
3635 Manassas Dr
Suite a
Roanoke, VA 24018-4031
Phone
(540) 774-4686
Fax
(540) 989-8893
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810002134 VA Primary

Addresses

Primary practice location

3635 Manassas Dr
Suite a
Roanoke, VA 24018-4031

Mailing address

2121 Lake Ave.
VA Medical Center
Ft. Wayne, IN 46805
Phone (260) 426-5431

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)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810002134VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Onstead Counseling Services LLC Past Accepting new patients
Windowlights, LLC Past Accepting new patients
Avery E Kerr Dmin LPC LLC PastSince Nov 10, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264118400000",
    "number": "1780604470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE.",
            "address_2": "VA MEDICAL CENTER",
            "city": "FT. WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-426-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 MANASSAS DR",
            "address_2": "SUITE A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184031",
            "telephone_number": "540-774-4686",
            "fax_number": "540-989-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENISON",
        "first_name": "EDWARD",
        "middle_name": "HUGH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2010-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810002134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; 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.