Healthcare Provider Details

I. General information

NPI: 1861639411
Provider Name (Legal Business Name): MARJORY ANNE TEBBE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2009
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 N 67TH AVE STE 400
GLENDALE AZ
85308-3698
US

IV. Provider business mailing address

17100 N 67TH AVE STE 400
GLENDALE AZ
85308-3698
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3323
  • Fax: 602-938-1626
Mailing address:
  • Phone: 602-938-3323
  • Fax: 602-938-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-11039
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: