Provider Demographics
NPI:1588372197
Name:LIBUS, ALAN (RADT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:LIBUS
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 ATLANTIC AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3535
Mailing Address - Country:US
Mailing Address - Phone:562-263-4733
Mailing Address - Fax:
Practice Address - Street 1:3939 ATLANTIC AVE STE 102
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3535
Practice Address - Country:US
Practice Address - Phone:562-263-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CACI37240123101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator