Provider Demographics
NPI:1265652622
Name:LYBARGER, RONALD LEON (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEON
Last Name:LYBARGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23402 WEST 45TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-2430
Mailing Address - Country:US
Mailing Address - Phone:816-228-3217
Mailing Address - Fax:
Practice Address - Street 1:23402 W 45TH TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-2430
Practice Address - Country:US
Practice Address - Phone:816-228-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1108103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist