Healthcare Provider Details

I. General information

NPI: 1205236841
Provider Name (Legal Business Name): AMY SUZANNE TIBBLES LMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 10TH ST
ANACORTES WA
98221-4139
US

IV. Provider business mailing address

13760 TIBBLES LN
ANACORTES WA
98221-8236
US

V. Phone/Fax

Practice location:
  • Phone: 360-770-7634
  • Fax:
Mailing address:
  • Phone: 360-770-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC50714
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60851405
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: