Provider Demographics
NPI:1861038234
Name:TABE, THERESIA ZUH (PMHNP)
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:ZUH
Last Name:TABE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:THERESIA
Other - Middle Name:
Other - Last Name:TABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:15625 LEADENHALL ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-7603
Mailing Address - Country:US
Mailing Address - Phone:301-221-8662
Mailing Address - Fax:
Practice Address - Street 1:4301 MAPLESHADE LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-0010
Practice Address - Country:US
Practice Address - Phone:301-221-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939880163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty