Mack B. Stephenson, Ph.d., Chtd

NPI #1093860561 in Meridian, Idaho

Provider Information

NPI Number: 1093860561
Entity Type: Organization
Organization Name: Mack B. Stephenson, Ph.d., Chtd
Primary Specialty: Psychologist
Enumeration Date: Jan 24, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 78 SW 5TH AVE
Address 2: SUITE 2
City: Meridian
State: Idaho
ZIP Code: 83642-2923
Phone: (208) 288-0692

Authorized Official

Name: MACK B. STEPHENSON, PH.D.
Title: PRESIDENT
Phone: (208) 288-0692

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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