Provider Demographics
NPI:1851693097
Name:TICHELBAUT, BARBARA J (LPCINTERN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:J
Last Name:TICHELBAUT
Suffix:
Gender:F
Credentials:LPCINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 SHARPSBURY DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4097
Mailing Address - Country:US
Mailing Address - Phone:817-545-3371
Mailing Address - Fax:817-545-4512
Practice Address - Street 1:1903 SHARPSBURY DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4097
Practice Address - Country:US
Practice Address - Phone:817-545-3371
Practice Address - Fax:817-545-4512
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health