Basic Information
| Provider Information | |||||||||
| NPI: | 1215245501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | FLENOID DEBRITT | ||||||||
| MiddleName: | TRISTAN | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E GILBERT ST | ||||||||
| Address2: | COTTAGE 4 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924150002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877001 | ||||||||
| FaxNumber: | 9093877611 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E GILBERT ST | ||||||||
| Address2: | COTTAGE 4 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924150002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877001 | ||||||||
| FaxNumber: | 9093877611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.