Provider Demographics
NPI:1114181989
Name:TEBBS, JEFFREY S (DNP, PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:TEBBS
Suffix:
Gender:M
Credentials:DNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COLUMBIA ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1098
Mailing Address - Country:US
Mailing Address - Phone:360-878-9312
Mailing Address - Fax:
Practice Address - Street 1:525 COLUMBIA ST NW STE 202
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1098
Practice Address - Country:US
Practice Address - Phone:360-878-9312
Practice Address - Fax:360-878-9887
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11996960-4405363LP0808X
WARN00164186163WP0809X
WAAP60045999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult