Provider Demographics
NPI:1780491977
Name:MUTUA, TABITHA MBITHE
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:MBITHE
Last Name:MUTUA
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 1:6007 LIVERPOOL ST
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1914
Mailing Address - Country:US
Mailing Address - Phone:469-238-9399
Mailing Address - Fax:
Practice Address - Street 1:6007 LIVERPOOL ST
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1914
Practice Address - Country:US
Practice Address - Phone:469-238-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health