Provider Demographics
NPI:1588858898
Name:TEBEJE, WOUBISHET DEMEWOZU (BA, MA)
Entity Type:Individual
Prefix:MR
First Name:WOUBISHET
Middle Name:DEMEWOZU
Last Name:TEBEJE
Suffix:
Gender:M
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 STARBIRD CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117
Mailing Address - Country:US
Mailing Address - Phone:408-505-1777
Mailing Address - Fax:
Practice Address - Street 1:1118 STARBIRD CIR APT 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-2837
Practice Address - Country:US
Practice Address - Phone:408-505-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
CA27022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health