Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | WV 878 | WV |
Y | 103T00000X | Psychologist | WV 878 | WV |
NPI | 1003905464 |
---|---|
Provider Name | Ms. Brenda Lea Tebay |
First Address | Harrisville, WV 26362-0373 |
Second Address | Parkersburg, WV 26101-4889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810000161 | (05) | WV |