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NPI Code Detail

MEDICARE: NIKKI LYNN LIBBY LPC

MEDICARE: NIKKI LYNN LIBBY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLPC-20266AZ

General Provider Information

NPI Number : 1174233381
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKKI LYNN LIBBY LPC
Provider Business Mailing Address
First Line : 401 W BASELINE RD STE 108
Second Line :
City : TEMPE
State : AZ
Zip : 85283-5349
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 401 W BASELINE RD
Second Line :
City : TEMPE
State : AZ
Zip : 85283-5348
Country : US
Telephone Number : 480-201-6192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2022
Last Update Date : 11/29/2022

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Directions to “ NIKKI LYNN LIBBY LPC” Practice Location

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