Individual
TEDD A STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
2112 N ROAN ST FL 6, JOHNSON CITY, TN 37601-2519
(423) 928-1379
(423) 928-1379
Mailing address
PO BOX 4644, JOHNSON CITY, TN 37602-4644
(423) 928-1379
(423) 928-1379
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
P0000001029
TN
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
CMT0000000186
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3688713
—
TN
Enumeration date
07/26/2006
Last updated
09/11/2025
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