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NPI Code Detail

MEDICARE: HOLLIS TIBBETTS

MEDICARE: HOLLIS TIBBETTS
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 Counselor

General Provider Information

NPI Number : 1427911379
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLIS TIBBETTS
Provider Business Mailing Address
First Line : 218 W 1ST ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-2746
Country : US
Telephone Number : 607-737-2490
Fax Number :
Provider Business Practice Location Address
First Line : 310 PENNSYLVANIA AVE
Second Line :
City : ELMIRA
State : NY
Zip : 14904-1458
Country : US
Telephone Number : 607-737-2490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ HOLLIS TIBBETTS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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