Provider Demographics
NPI:1285133884
Name:WEBB, MAKEDA NICOLE
Entity type:Individual
Prefix:
First Name:MAKEDA
Middle Name:NICOLE
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 S 33RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-7411
Mailing Address - Country:US
Mailing Address - Phone:602-705-7308
Mailing Address - Fax:
Practice Address - Street 1:1122 E BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-4020
Practice Address - Country:US
Practice Address - Phone:602-705-7308
Practice Address - Fax:602-252-2482
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty