Organization
MACK B. STEPHENSON, PH.D., CHTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACK B. STEPHENSON PH.D. (PRESIDENT)
(208) 288-0692
Entity
Organization
Contact information
Practice address
78 SW 5TH AVE, SUITE 2, MERIDIAN, ID 83642-2923
(208) 288-0692
(208) 288-0467
Mailing address
78 SW 5TH AVE, SUITE 2, MERIDIAN, ID 83642-2923
(208) 288-0692
(208) 288-0467
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-202056
ID
Other
Enumeration date
01/24/2007
Last updated
08/22/2020
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