Provider Demographics
NPI:1740282870
Name:HEBDA, JAMES R (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:HEBDA
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 1:130 HILLCREST DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5000
Mailing Address - Country:US
Mailing Address - Phone:931-553-8500
Mailing Address - Fax:931-553-8544
Practice Address - Street 1:130 HILLCREST DR
Practice Address - Street 2:SUITE 107
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5000
Practice Address - Country:US
Practice Address - Phone:931-553-8500
Practice Address - Fax:931-553-8544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1266103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN79923OtherBLUE CROSS BLUE SHIELD
TN3685981Medicare ID - Type Unspecified