Provider Demographics
NPI:1548352511
Name:TEBBE, MICHAEL LEE (MSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:TEBBE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11385 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249
Mailing Address - Country:US
Mailing Address - Phone:513-469-6226
Mailing Address - Fax:513-469-6277
Practice Address - Street 1:11385 MONTGOMERY ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-469-6226
Practice Address - Fax:513-469-6277
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI27711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982420000Medicare UPIN