Provider Demographics
NPI:1417932625
Name:LEFTON, WILLIAM JACK (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACK
Last Name:LEFTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 AIRPARK DR
Mailing Address - Street 2:BEHAVIORAL HEALTH ASSOCIATES
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2988
Mailing Address - Country:US
Mailing Address - Phone:423-899-0024
Mailing Address - Fax:423-899-5688
Practice Address - Street 1:6216 AIRPARK DR
Practice Address - Street 2:BEHAVIORAL HEALTH ASSOCIATES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2988
Practice Address - Country:US
Practice Address - Phone:423-899-0024
Practice Address - Fax:423-899-5688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP899103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3681399Medicaid
3069838OtherBLUE CROSS BLUE SHIELD
TN3681399Medicaid