Provider Demographics
NPI:1285757013
Name:SIMPSON, MARK THEODORE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THEODORE
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:310 25TH AVE N STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2492
Mailing Address - Country:US
Mailing Address - Phone:615-385-4090
Mailing Address - Fax:615-385-0138
Practice Address - Street 1:119 BOONE RIDGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615
Practice Address - Country:US
Practice Address - Phone:865-673-6741
Practice Address - Fax:865-673-6634
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical