Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301014303 | MI |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301014303 | MI |
NPI | 1235466400 |
---|---|
Provider Name | James C Teegarden |
First Address | Oxford, MI 48371-6108 |
Second Address | Oxford, MI 48371-6108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2009 |
Last Update Date | 07/03/2013 |