Provider Demographics
NPI:1639664188
Name:WEBB, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WEBB
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 1:3650 SOUTH POINTE CIR STE 208
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0423
Mailing Address - Country:US
Mailing Address - Phone:702-298-5313
Mailing Address - Fax:
Practice Address - Street 1:3650 SOUTH POINTE CIR STE 208
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0423
Practice Address - Country:US
Practice Address - Phone:702-298-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician