Provider Demographics
NPI:1013288950
Name:TEBO, CECILE WATTERS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CECILE
Middle Name:WATTERS
Last Name:TEBO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 VINCENNES PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4352
Mailing Address - Country:US
Mailing Address - Phone:504-908-5799
Mailing Address - Fax:
Practice Address - Street 1:3528 VINCENNES PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-4352
Practice Address - Country:US
Practice Address - Phone:504-908-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional