Healthcare Provider Details

I. General information

NPI: 1013369214
Provider Name (Legal Business Name): LINDY TIBBLING SUDP/T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LINCOLN AVE
YAKIMA WA
98901-2348
US

IV. Provider business mailing address

131 CANYON CT
RICHLAND WA
99352-9409
US

V. Phone/Fax

Practice location:
  • Phone: 509-457-5653
  • Fax:
Mailing address:
  • Phone: 509-457-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70052924
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: