Provider Demographics
NPI:1982483376
Name:TAMBE EBOT, GAEL E
Entity Type:Individual
Prefix:
First Name:GAEL
Middle Name:E
Last Name:TAMBE EBOT
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 1:450 N EUCALYPTUS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8257
Mailing Address - Country:US
Mailing Address - Phone:602-334-8232
Mailing Address - Fax:602-838-8867
Practice Address - Street 1:450 N EUCALYPTUS PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8257
Practice Address - Country:US
Practice Address - Phone:602-334-8232
Practice Address - Fax:602-838-8867
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty