Provider Demographics
NPI:1477157386
Name:TUBBS, AIMEE NOELLE (EDS)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:NOELLE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:LOUISIANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 111 BOX 2F
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09454-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1327 S 100 E UNIT 3
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2374
Practice Address - Country:US
Practice Address - Phone:801-310-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT557272103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool