MEDICARE: DR. ACE LEONARD TUBBS JR. PHD

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	103TC0700X	Clinical Psychologist	0810000253	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	433818	OTHER	VA	ANTHEM BC

General Provider Information

NPI Number	:	1841273273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ACE LEONARD TUBBS JR. PHD

Provider Business Mailing Address
First Line	:	1560 BORDEAUX PL
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1314
Country	:	US
Telephone Number	:	757-622-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 BORDEAUX PL
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1314
Country	:	US
Telephone Number	:	757-622-6242
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	05/13/2016

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