Healthcare Provider Details

I. General information

NPI: 1861038234
Provider Name (Legal Business Name): THERESIA ZUH TABE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESIA TABE PMHNP

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 MAPLESHADE LN
PLANO TX
75093-0010
US

IV. Provider business mailing address

15625 LEADENHALL ST
FRISCO TX
75036-7603
US

V. Phone/Fax

Practice location:
  • Phone: 301-221-8662
  • Fax:
Mailing address:
  • Phone: 301-221-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number939880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: