Provider Demographics
NPI:1588916043
Name:TIBBS, NICHOLAS EVAN
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:EVAN
Last Name:TIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-0287
Mailing Address - Country:US
Mailing Address - Phone:435-835-4381
Mailing Address - Fax:435-835-4380
Practice Address - Street 1:920 NORTH CENTERLINE DR.
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642
Practice Address - Country:US
Practice Address - Phone:435-835-4381
Practice Address - Fax:435-835-4380
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor