Healthcare Provider Details

I. General information

NPI: 1679055412
Provider Name (Legal Business Name): NATALIE WEBBER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 W IRON SPRINGS RD
PRESCOTT AZ
86305-1623
US

IV. Provider business mailing address

PO BOX 1366
BAGDAD AZ
86321-1366
US

V. Phone/Fax

Practice location:
  • Phone: 928-899-1104
  • Fax:
Mailing address:
  • Phone: 928-243-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLCSW-17218
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLCSW-17218
License Number StateAZ

VIII. Authorized Official

Name: NATALIE JO WEBBER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 928-899-1104