Provider Demographics
NPI:1710348545
Name:TIBBITS, STEVEN (PEER COUNSELOR)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TIBBITS
Suffix:
Gender:M
Credentials:PEER COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2489
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-2489
Mailing Address - Country:US
Mailing Address - Phone:360-397-8070
Mailing Address - Fax:360-397-8017
Practice Address - Street 1:1601 E 4TH PLAIN BLVD
Practice Address - Street 2:BULIDING 17 SUITE C106
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-397-8070
Practice Address - Fax:360-397-8017
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60573046101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor