Provider Demographics
NPI:1003355843
Name:TEBBE, ELLIOT AARON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:AARON
Last Name:TEBBE
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 1:419 S MILLS ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1615
Mailing Address - Country:US
Mailing Address - Phone:320-339-9992
Mailing Address - Fax:
Practice Address - Street 1:419 S MILLS ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1615
Practice Address - Country:US
Practice Address - Phone:320-339-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI392857103TC0700X
MNLP6441103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical