Provider Demographics
NPI:1265467443
Name:BILBREY, LEROY V (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:V
Last Name:BILBREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:V
Other - Last Name:BILBREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0321
Mailing Address - Country:US
Mailing Address - Phone:931-528-8801
Mailing Address - Fax:931-839-7828
Practice Address - Street 1:427 N WILLOW AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2354
Practice Address - Country:US
Practice Address - Phone:931-528-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684928Medicare ID - Type Unspecified