Provider Demographics
NPI:1376722785
Name:WEBB, MARY LEE (PHD)
Entity Type:Individual
Prefix:
First Name:MARY LEE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 H ST
Mailing Address - Street 2:PMB 1050
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5110
Mailing Address - Country:US
Mailing Address - Phone:360-922-0155
Mailing Address - Fax:
Practice Address - Street 1:225 MARINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4027
Practice Address - Country:US
Practice Address - Phone:360-922-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202086103TC0700X
WATE00003766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical