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General NPI Number Information
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NPI Number | 1548418064
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Entity Type | Individual
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Provider Name | THOMAS TYBECK LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 324 S KENSINGTON AVE STE 328
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City | LECANTO
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State | FL
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Zip | 34461
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Country | US
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Telephone | 352-422-1668
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 N TSALA APOPKA DR
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City | HERNANDO
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State | FL
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Zip | 34442-7900
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Country | US
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Telephone | 352-422-1668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004432
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License Number State | VA
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