Provider Demographics
NPI:1336820711
Name:KIBBE, CHARLES TYLER (LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:TYLER
Last Name:KIBBE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9591
Mailing Address - Country:US
Mailing Address - Phone:501-259-3316
Mailing Address - Fax:
Practice Address - Street 1:9209 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9591
Practice Address - Country:US
Practice Address - Phone:972-698-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health