Provider Demographics
NPI:1841413697
Name:PHIBBS, ALMA CATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:CATHERINE
Last Name:PHIBBS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AMERICAN BLVD E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1392
Mailing Address - Country:US
Mailing Address - Phone:952-854-7200
Mailing Address - Fax:952-854-7772
Practice Address - Street 1:900 AMERICAN BLVD E
Practice Address - Street 2:SUITE 103
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1392
Practice Address - Country:US
Practice Address - Phone:952-854-7200
Practice Address - Fax:952-854-7772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN165841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7680218OtherMN CARE TAX ID
MN992N6PHOtherBLUE CROSS BLUE SHIELD