Provider Demographics
NPI:1639734288
Name:TIBBET, SCOTT CHARLES
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHARLES
Last Name:TIBBET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 ESPLANADE SPC 256
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4942
Mailing Address - Country:US
Mailing Address - Phone:530-809-0514
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2281
Practice Address - Country:US
Practice Address - Phone:530-508-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician