Provider Demographics
NPI:1417588229
Name:TEBAY, AMBER N (PHD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:TEBAY
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 1:710 BELROCK AVE APT 120
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2152
Mailing Address - Country:US
Mailing Address - Phone:304-966-1286
Mailing Address - Fax:
Practice Address - Street 1:210 N 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-374-6338
Practice Address - Fax:740-374-6066
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8003103TH0004X, 103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth