Provider Demographics
NPI:1871460196
Name:EBERHARDT, TABATHA ALEAN I
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:ALEAN
Last Name:EBERHARDT
Suffix:I
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 1:6313 SIERRA PINES CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2344
Mailing Address - Country:US
Mailing Address - Phone:702-205-7165
Mailing Address - Fax:
Practice Address - Street 1:6313 SIERRA PINES CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2344
Practice Address - Country:US
Practice Address - Phone:702-205-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1402335745405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty