MEDICARE: KEIQUANTYANA BIBBINS 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
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator		LA
3	101YM0800X	Mental Health Counselor	87391	TX

General Provider Information

NPI Number	:	1538698659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIQUANTYANA BIBBINS LPC

Provider Business Mailing Address
First Line	:	12656 CROSSROADS PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12656 CROSSROADS PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3371
Country	:	US
Telephone Number	:	504-239-0248
Fax Number	:

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	01/28/2026

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