Provider Demographics
NPI:1205012242
Name:ACREE, TABITHA LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LYNN
Last Name:ACREE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4316
Mailing Address - Country:US
Mailing Address - Phone:515-408-0416
Mailing Address - Fax:515-955-8593
Practice Address - Street 1:300 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4316
Practice Address - Country:US
Practice Address - Phone:515-408-0416
Practice Address - Fax:515-955-8593
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical