Provider Demographics
NPI:1588809750
Name:BIBBS, MICHAEL WAYNE (LPE-I)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:BIBBS
Suffix:
Gender:M
Credentials:LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CENTERVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4312
Mailing Address - Country:US
Mailing Address - Phone:501-644-9744
Mailing Address - Fax:
Practice Address - Street 1:1701 CENTERVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4312
Practice Address - Country:US
Practice Address - Phone:501-644-9744
Practice Address - Fax:501-492-6473
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-13EI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist