Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 9838 | TX |
Y | 101YM0800X | Mental Health Counselor | 63885 | TX |
NPI | 1003119769 |
---|---|
Provider Name | Michael David Webb |
First Address | Fort Worth, TX 76244-9119 |
Second Address | Keller, TX 76248-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2010 |
Last Update Date | 17/12/2010 |