Provider Demographics
NPI:1639208309
Name:BROWN, LIBBY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LIBBY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LIBBY
Other - Middle Name:L
Other - Last Name:BETHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:7409 EAGLE CREST BLVD STE G
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9136
Practice Address - Country:US
Practice Address - Phone:812-842-4020
Practice Address - Fax:812-842-4019
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1068103TC0700X
IN20041288A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100153380Medicaid
KY000000709939OtherANTHEM BC/BS
IN20041288AOtherSTATE LICENSE
IN300017911Medicaid