Individual
SUSAN ILENE TAUB
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1604 E OAKLAND AVE, JOHNSON CITY, TN 37601-2151
(423) 928-2222
(423) 926-5455
Mailing address
1604 E OAKLAND AVE, JOHNSON CITY, TN 37601-2151
(423) 928-2222
(423) 926-5455
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P0000001182
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005354369
AETNA
—
01
—
014511
VALUE OPTIONS
—
01
—
3689675
CIGNA BH
—
05
—
3689675
—
SD
01
—
82899
BCBS
—
Enumeration date
12/15/2005
Last updated
07/08/2007
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