Provider Information for 1902358369
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BETH TABBERT LPC
Sex: Female
NPI: 1902358369
Last Updated: 2016-11-01
Certification Date:
Certification Date:
Details
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NPI | 1902358369 | ||||||||
Enumeration Date | 2016-11-01 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 309 W CLARK ST CHAMPAIGN, IL 61820-4637 United States Phone: 217-398-9066 | Fax:217-398-9077 | ||||||||
Primary Practice Address | 309 W CLARK ST CHAMPAIGN, IL 61820-4637 United States Phone: 217-398-9066 | Fax:217-398-9077 | ||||||||
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