Provider Demographics
NPI:1538977087
Name:TABB CLINICAL & CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:TABB CLINICAL & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-617-7182
Mailing Address - Street 1:257 FIREWEED LN
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9536
Mailing Address - Country:US
Mailing Address - Phone:907-617-7182
Mailing Address - Fax:
Practice Address - Street 1:257 FIREWEED LN
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9536
Practice Address - Country:US
Practice Address - Phone:907-617-7182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty