MEDICARE: DR. CARMEN MARIE TEBBE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1073	OK

General Provider Information

NPI Number	:	1649509266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN MARIE TEBBE PH.D.

Provider Business Mailing Address
First Line	:	300 36TH AVE SW APT 531
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-5051
Country	:	US
Telephone Number	:	405-620-4127
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 W MAIN ST STE 102
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-6851
Country	:	US
Telephone Number	:	405-620-4127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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