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General NPI Number Information
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NPI Number | 1669602744
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Entity Type | Organization
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Legal Business Name | EARNEST WEBB, PC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 849 MAPLE AVE SUITE 903
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City | HOMEWOOD
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State | IL
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Zip | 60430-2066
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Country | US
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Telephone | 708-799-5862
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Fax | 708-799-0138
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Provider Business Mailing Address
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Address Line | 19516 NORTHWINDS DR
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City | LYNWOOD
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State | IL
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Zip | 60411-8660
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Country | US
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Telephone | 708-251-5118
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EARNEST WEBB
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Credential | PH.D.
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Telephone | 708-799-5862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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