Provider Demographics
NPI:1467888164
Name:HIBBARD, ALLISON (LMFT, LAADC-CA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:LMFT, LAADC-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19007
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-0007
Mailing Address - Country:US
Mailing Address - Phone:530-600-6505
Mailing Address - Fax:
Practice Address - Street 1:2494 LAKE TAHOE BLVD STE B7
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7142
Practice Address - Country:US
Practice Address - Phone:530-600-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI12030518101YA0400X
CA123915106H00000X
NV06577-PC101YA0400X
NV3308-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)