Healthcare Provider Details

I. General information

NPI: 1881907111
Provider Name (Legal Business Name): MADOLYN LIEBING M.F.T, PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 N 400 W
MANTI UT
84642-1037
US

IV. Provider business mailing address

397 N 400 W
MANTI UT
84642-1037
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4690
  • Fax:
Mailing address:
  • Phone: 435-283-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number114581-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: