Provider Demographics
NPI:1588808752
Name:SIBIS ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:SIBIS ENTERPRISES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, EDD, LMHC
Authorized Official - Phone:219-864-0156
Mailing Address - Street 1:3195 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-1006
Mailing Address - Country:US
Mailing Address - Phone:219-864-0156
Mailing Address - Fax:219-362-3093
Practice Address - Street 1:7451 HARVEST DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3470
Practice Address - Country:US
Practice Address - Phone:219-864-0156
Practice Address - Fax:219-362-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000758A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty