Healthcare Provider Details

I. General information

NPI: 1972442283
Provider Name (Legal Business Name): DUSTIN TIBBITTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MING AVE STE 410
BAKERSFIELD CA
93309-4631
US

IV. Provider business mailing address

5500 MING AVE STE 410
BAKERSFIELD CA
93309-4631
US

V. Phone/Fax

Practice location:
  • Phone: 661-622-4132
  • Fax:
Mailing address:
  • Phone: 661-622-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5849329-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: