Healthcare Provider Details

I. General information

NPI: 1548717655
Provider Name (Legal Business Name): MRS. TANEISHA CORTNEY LYBBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TANEISHA CORTNEY MCCOY

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E 2ND AVE STE 201
SPOKANE WA
99202-1455
US

IV. Provider business mailing address

323 E 2ND AVE STE 201
SPOKANE WA
99202-1455
US

V. Phone/Fax

Practice location:
  • Phone: 509-418-4484
  • Fax: 509-381-3470
Mailing address:
  • Phone: 509-418-4484
  • Fax: 509-381-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61502070
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: