Healthcare Provider Details
I. General information
NPI: 1427574748
Provider Name (Legal Business Name): WILLIAM THOMAS BIBB JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 08/17/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1675 ANSEL RD
CLEVELAND OH
44106-4181
US
IV. Provider business mailing address
1675 ANSEL RD APT 1329
CLEVELAND OH
44106-4175
US
V. Phone/Fax
- Phone: 216-299-7780
- Fax:
- Phone: 216-299-7780
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 161717 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174H00000X |
| Taxonomy | Health Educator |
| License Number | 161717 |
| License Number State | OH |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 161717 |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | 161717 |
| License Number State | OH |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP0904X |
| Taxonomy | Federal Public Health Clinic/Center |
| License Number | 161717 |
| License Number State | OH |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225800000X |
| Taxonomy | Recreation Therapist |
| License Number | 161717 |
| License Number State | OH |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 405300000X |
| Taxonomy | Prevention Professional |
| License Number | 161717 |
| License Number State | OH |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133NN1002X |
| Taxonomy | Nutrition Education Nutritionist |
| License Number | 161717 |
| License Number State | OH |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1744R1102X |
| Taxonomy | Research Study Specialist |
| License Number | 161717 |
| License Number State | OH |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171400000X |
| Taxonomy | Health & Wellness Coach |
| License Number | 161717 |
| License Number State | OH |
| # 11 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251K00000X |
| Taxonomy | Public Health or Welfare Agency |
| License Number | 161717 |
| License Number State | OH |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 161717 |
| License Number State | OH |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 161717 |
| License Number State | OH |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | 161717 |
| License Number State | OH |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | 161717 |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
