Healthcare Provider Details

I. General information

NPI: 1508416595
Provider Name (Legal Business Name): TYECHIA WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21239 N 24TH AVE APT 214
PHOENIX AZ
85027-2524
US

IV. Provider business mailing address

21239 N 24TH AVE APT 214
PHOENIX AZ
85027-2524
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-2349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number9944280
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number9944280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: