Provider Demographics
NPI:1184829103
Name:BIBINS-CLARK, RANDI YVONNE (LMHP, PMSW)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:YVONNE
Last Name:BIBINS-CLARK
Suffix:
Gender:F
Credentials:LMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1265
Mailing Address - Country:US
Mailing Address - Phone:402-573-1080
Mailing Address - Fax:
Practice Address - Street 1:6002A WENNINGHOFF RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1903
Practice Address - Country:US
Practice Address - Phone:402-850-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health