Basic Information
| Provider Information | |||||||||
| NPI: | 1487755658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER-GILBERT | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MS, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24371 | ||||||||
| Address2: | |||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454240371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377712977 | ||||||||
| FaxNumber: | 9378328711 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 N MAIN ST STE 333 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454151185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377712977 | ||||||||
| FaxNumber: | 9378328711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0003042 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000000315420 | 01 | OH | ANTHEM BC/BS | OTHER |