Provider Demographics
NPI:1902322563
Name:WEBBER, TANYA (MS)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WEBBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2009
Mailing Address - Country:US
Mailing Address - Phone:662-245-7097
Mailing Address - Fax:662-245-0511
Practice Address - Street 1:2623 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2009
Practice Address - Country:US
Practice Address - Phone:662-241-7097
Practice Address - Fax:662-245-0511
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000014Medicaid