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Individual

DR. STEPHEN LEANDER CHESHIRE III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
2235 MAIN ST NE, SUITE C, LOS LUNAS, NM 87031
(505) 916-0820
Mailing address
2235 MAIN ST NE, SUITE C, LOS LUNAS, NM 87031
(505) 916-0820

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1251
NM
103TC0700X
Clinical Psychologist
PSY002308
GA
103TP0016X
Prescribing (Medical) Psychologist
Primary
0042
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000896816D
GA
01
277711000
MAGELLAN PROVIDER ID
GA
Enumeration date
01/04/2007
Last updated
09/13/2017
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