Provider Demographics
NPI:1649367707
Name:STEPHEN C. WESTMORELAND, PC
Entity type:Organization
Organization Name:STEPHEN C. WESTMORELAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:903-593-8395
Mailing Address - Street 1:1810 SHILOH RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2419
Mailing Address - Country:US
Mailing Address - Phone:903-593-8395
Mailing Address - Fax:903-581-8679
Practice Address - Street 1:1810 SHILOH RD
Practice Address - Street 2:SUITE 801
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2419
Practice Address - Country:US
Practice Address - Phone:903-593-8395
Practice Address - Fax:903-581-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21579103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00956YMedicare ID - Type Unspecified