Individual
DR. THEODORE L BALDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3950 CENTRAL AVE, MEMPHIS, TN 38111-7602
(901) 458-6291
(901) 323-4848
Mailing address
3950 CENTRAL AVE, MEMPHIS, TN 38111-7602
(901) 458-6291
(901) 323-4848
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
27365
MS
103TA0400X
Addiction (Substance Use Disorder) Psychologist
P0000000685
TN
103TC0700X
Clinical Psychologist
Primary
P0000000685
TN
103TP2701X
Group Psychotherapy Psychologist
P0000000685
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009713
TN BLUE SHIELD
TN
01
—
2033550
CIGNA
TN
Enumeration date
07/27/2005
Last updated
02/04/2008
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