Provider Demographics
NPI:1194070946
Name:WEBB, JON R (PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:R
Last Name:WEBB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:807 UNIVERSITY PKWY
Mailing Address - Street 2:BOX 70649, ETSU
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-6500
Mailing Address - Country:US
Mailing Address - Phone:423-439-4466
Mailing Address - Fax:423-439-5695
Practice Address - Street 1:807 UNIVERSITY PKWY
Practice Address - Street 2:139 LUCILLE CLEMENT HALL
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6500
Practice Address - Country:US
Practice Address - Phone:423-439-7777
Practice Address - Fax:423-439-7780
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNP2762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical