Provider Demographics
NPI:1639213945
Name:HIBBS, DOYLE DEAN JR (BS)
Entity Type:Individual
Prefix:MR
First Name:DOYLE
Middle Name:DEAN
Last Name:HIBBS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:DOYLE
Other - Middle Name:DEAN
Other - Last Name:HIBBS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:2135 W 12TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3559
Mailing Address - Country:US
Mailing Address - Phone:541-338-0262
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3758
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health