Provider Demographics
NPI:1679022206
Name:STANG, BIBI (PHD)
Entity Type:Individual
Prefix:DR
First Name:BIBI
Middle Name:
Last Name:STANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4423
Mailing Address - Country:US
Mailing Address - Phone:602-406-3473
Mailing Address - Fax:602-406-4406
Practice Address - Street 1:222 W THOMAS RD STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4423
Practice Address - Country:US
Practice Address - Phone:602-406-3473
Practice Address - Fax:602-406-4406
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4747103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831215Medicaid
AZZ77809Medicare UPIN