Healthcare Provider Details

I. General information

NPI: 1770171118
Provider Name (Legal Business Name): JAMIE HIBBS MS, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 S MAIN ST
PLYMOUTH MI
48170-2217
US

IV. Provider business mailing address

535 GRISWOLD STREET SUITE 111 #306
DETROIT MI
48226
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax:
Mailing address:
  • Phone: 734-648-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: