Provider Demographics
NPI:1326143074
Name:BIBB, JAMES LYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LYLE
Last Name:BIBB
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 1:45-020A MALULANI STREET
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2433
Mailing Address - Country:US
Mailing Address - Phone:808-375-1850
Mailing Address - Fax:808-235-6622
Practice Address - Street 1:45-020A MALULANI STREET
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2433
Practice Address - Country:US
Practice Address - Phone:808-375-1850
Practice Address - Fax:808-235-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI192823OtherHMN SUMMERLIN NUMBER
HI9412-8OtherHMSA PROVIDER NUMBER
HI192823 / I1OtherHMA INC. DBA MANAGEMENT
HIPSY387OtherMDX HAWAII
HIH50001Medicare PIN
HI192823OtherHMN SUMMERLIN NUMBER