Provider Demographics
NPI:1518393958
Name:WEBB02, TINA
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:WEBB02
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 VIA CANALE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0828
Mailing Address - Country:US
Mailing Address - Phone:702-883-1554
Mailing Address - Fax:
Practice Address - Street 1:930 VIA CANALE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-0828
Practice Address - Country:US
Practice Address - Phone:702-883-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1701709061Medicaid