Provider Demographics
NPI:1184830143
Name:ALTFELD, TOBY S (SPE)
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:S
Last Name:ALTFELD
Suffix:
Gender:M
Credentials:SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3963
Mailing Address - Country:US
Mailing Address - Phone:731-394-0749
Mailing Address - Fax:731-512-3875
Practice Address - Street 1:156 C WEST UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-394-0749
Practice Address - Fax:731-512-3875
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000000388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist