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General NPI Number Information
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NPI Number | 1770171118
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Entity Type | Individual
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Provider Name | JAMIE HIBBS MS, TLLP
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Gender | Female
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 1307 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2217
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Country | US
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Telephone | 734-451-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 535 GRISWOLD STREET SUITE 111 #306
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City | DETROIT
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State | MI
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Zip | 48226
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Country | US
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Telephone | 734-648-6353
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362009227
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License Number State | MI
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