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General NPI Number Information
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NPI Number | 1194070946
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Entity Type | Individual
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Provider Name | JON R. WEBB PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 807 UNIVERSITY PKWY 139 LUCILLE CLEMENT HALL
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City | JOHNSON CITY
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State | TN
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Zip | 37614-6500
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Country | US
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Telephone | 423-439-7777
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Fax | 423-439-7780
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Provider Business Mailing Address
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Address Line | 807 UNIVERSITY PKWY BOX 70649, ETSU
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City | JOHNSON CITY
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State | TN
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Zip | 37614-6500
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Country | US
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Telephone | 423-439-4466
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Fax | 423-439-5695
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P2762
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License Number State | TN
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