1942540471 NPI number — ALICE MARIE TIBBALS LMHC

Table of content: ALICE MARIE TIBBALS LMHC (NPI 1942540471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942540471 NPI number — ALICE MARIE TIBBALS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIBBALS
Provider First Name:
ALICE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942540471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W PATISON ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT HADLOCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98339-9794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-382-7006
Provider Business Mailing Address Fax Number:
360-382-7009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W PATISON ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HADLOCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98339-9794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-382-7006
Provider Business Practice Location Address Fax Number:
360-382-7009
Provider Enumeration Date:
02/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60335080 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2042543 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com