| Mack B. Stephenson, Ph.d., Chtd | |
|
78 Sw 5th Ave Suite 2 Meridian ID 83642-2923 | |
| (208) 288-0692 | |
| (208) 288-0467 |
| Full Name | Mack B. Stephenson, Ph.d., Chtd |
|---|---|
| Speciality | Psychologist |
| Location | 78 Sw 5th Ave, Meridian, Idaho |
| Authorized Official Name and Position | Mack B. Stephenson (PRESIDENT) |
| Authorized Official Contact | 2082880692 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mack B. Stephenson, Ph.d., Chtd 78 Sw 5th Ave Suite 2 Meridian ID 83642-2923 Ph: (208) 288-0692 | Mack B. Stephenson, Ph.d., Chtd 78 Sw 5th Ave Suite 2 Meridian ID 83642-2923 Ph: (208) 288-0692 |
| NPI Number | 1093860561 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093860561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY-202056 (Idaho) | Primary |
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