Provider Demographics
NPI:1336167410
Name:THAYER, STEPHEN H (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:THAYER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1246 NORTHERN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3717
Mailing Address - Country:US
Mailing Address - Phone:423-602-4393
Mailing Address - Fax:
Practice Address - Street 1:5010 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5175
Practice Address - Country:US
Practice Address - Phone:423-602-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEFT-0010138OtherLMFT
TN1076OtherLMFT
FLMT4610OtherLMFT
GAMFT001548OtherLMFT