Provider Demographics
NPI:1891981791
Name:SIBILLE, BRAD LOUIS (MA, LPC-S)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:LOUIS
Last Name:SIBILLE
Suffix:
Gender:M
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6137
Mailing Address - Country:US
Mailing Address - Phone:337-945-1032
Mailing Address - Fax:337-678-1893
Practice Address - Street 1:333 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6137
Practice Address - Country:US
Practice Address - Phone:337-945-1032
Practice Address - Fax:337-678-1893
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0008369101YP2500X
LA5048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3363691Medicaid