Active NPI
Elliot Aaron Tebbe, PH.D.
- Clinical Psychologist
- Madison, WI
National Provider Identifier
1003355843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 392857
- Practice address
- 419 S Mills St
Madison, WI 53715-1615 - Phone
- (320) 339-9992
- NPI assigned
- Feb 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 392857 | WI | Primary |
Addresses
Primary practice location
419 S Mills St
Madison, WI 53715-1615
Mailing address
419 S Mills St
Madison, WI 53715-1615
Phone (320) 339-9992
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 392857 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638144000000",
"number": "1003355843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 S MILLS ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151615",
"telephone_number": "320-339-9992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 S MILLS ST",
"city": "MADISON",
"state": "WI",
"postal_code": "537151615",
"telephone_number": "320-339-9992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBBE",
"first_name": "ELLIOT",
"middle_name": "AARON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-13",
"last_updated": "2021-11-29",
"certification_date": "2021-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "392857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.