Provider Demographics
NPI:1265579718
Name:WEBB, NATASHA L (LADC ,MA)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:L
Last Name:WEBB
Suffix:
Gender:F
Credentials:LADC ,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NW 166TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6807
Mailing Address - Country:US
Mailing Address - Phone:832-258-6866
Mailing Address - Fax:405-330-7812
Practice Address - Street 1:5350 S WESTERN AVE STE 530
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4536
Practice Address - Country:US
Practice Address - Phone:832-258-6866
Practice Address - Fax:405-400-0162
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5919101YP2500X
OK163101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200269730 AMedicaid