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Provider Information for 1902358369


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BETH TABBERT LPC


Sex: Female

NPI: 1902358369
Last Updated: 2016-11-01
Certification Date:

Details

NameValue
NPI1902358369
Enumeration Date2016-11-01
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalIL178.009282