Provider Demographics
NPI:1023103603
Name:WESTMORELAND, STEPHEN C (ED D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:WESTMORELAND
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8822
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8822
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
Practice Address - Country:US
Practice Address - Phone:903-593-8395
Practice Address - Fax:908-581-8679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00 EE 46Medicare PIN