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General NPI Number Information
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NPI Number | 1053618686
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Entity Type | Individual
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Provider Name | TABITHA NICOLE WEBSTER
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Gender | Female
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 750 N FREEDOM BLVD
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City | PROVO
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State | UT
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Zip | 84601-1677
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Country | US
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Telephone | 801-373-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 770 E MAIN ST #428
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City | LEHI
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State | UT
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Zip | 84043-2293
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 8749465-3902
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License Number State | UT
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