MEDICARE: WILLIAM THOMAS BIBB JR.

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
1	103TH0100X	Health Service Psychologist	161717	OH
2	174H00000X	Health Educator	161717	OH
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist	161717	OH
4	101Y00000X	Counselor	161717	OH
5	261QP0904X	Federal Public Health Clinic/Center	161717	OH
6	225800000X	Recreation Therapist	161717	OH
7	405300000X	Prevention Professional	161717	OH
8	133NN1002X	Nutrition Education Nutritionist	161717	OH
9	1744R1102X	Research Study Specialist	161717	OH
10	171400000X	Health & Wellness Coach	161717	OH
11	251K00000X	Public Health or Welfare Agency	161717	OH
12	101YA0400X	Addiction (Substance Use Disorder) Counselor	161717	OH
13	171M00000X	Case Manager/Care Coordinator	161717	OH
14	208D00000X	General Practice Physician	161717	OH
15	174400000X	Specialist	161717	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427574748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM THOMAS BIBB JR.

Provider Business Mailing Address
First Line	:	1675 ANSEL RD APT 1329
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-4175
Country	:	US
Telephone Number	:	216-299-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 ANSEL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-4181
Country	:	US
Telephone Number	:	216-299-7780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	10/06/2025

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