Provider Demographics
NPI:1104357334
Name:HIBBARD, KRISTABEL LEIGH (RBT)
Entity Type:Individual
Prefix:
First Name:KRISTABEL
Middle Name:LEIGH
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 UTAH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2703
Mailing Address - Country:US
Mailing Address - Phone:580-551-9594
Mailing Address - Fax:
Practice Address - Street 1:6628 SKY POINTE DR
Practice Address - Street 2:STE. 114
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4070
Practice Address - Country:US
Practice Address - Phone:702-449-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician