STEPHEN BLACKSTONE EDSTROM M.D. NPI 1396942264

NPI Information

  • NPI: 1396942264
  • Provider Name: STEPHEN BLACKSTONE EDSTROM, M.D.
  • Classification: Psychiatry & Neurology - 2084P0800X
  • Specialization: Psychiatry
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1100 WILFORD HALL LOOP BLDG 4554
    JBSA LACKLAND, TX
    ZIP 78236
  • Phone: (210) 292-6255

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NPI Details

Stephen Blackstone Edstrom, M.D. is a psychiatry psychiatry neurology in Jbsa Lackland, TX. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. Stephen Blackstone Edstrom, M.D. NPI is 1396942264. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX
ZIP 78236-638
Phone: (210) 292-6255
Fax: (210) 292-7934

The NPI 1396942264 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/2/2007 and was last updated on 6/6/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine01066091AINDIANANo
22084P0800XPsychiatry & NeurologyPsychiatry35.151601OHIOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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