Provider Demographics
NPI:1295422145
Name:WEBBER, TY BRYCE
Entity type:Individual
Prefix:
First Name:TY
Middle Name:BRYCE
Last Name:WEBBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N ST STE A
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3335
Mailing Address - Country:US
Mailing Address - Phone:872-444-4488
Mailing Address - Fax:
Practice Address - Street 1:900 N ST STE A
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-3335
Practice Address - Country:US
Practice Address - Phone:872-444-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician