Provider Demographics
NPI:1487037115
Name:LIBBY, NATALIE (BCBA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3425 COFFEE RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1582
Mailing Address - Country:US
Mailing Address - Phone:209-521-4791
Mailing Address - Fax:209-521-4794
Practice Address - Street 1:5501 ANTIQUE ROSE WAY
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9505
Practice Address - Country:US
Practice Address - Phone:209-521-4791
Practice Address - Fax:209-521-4794
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18666103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst