Provider Demographics
NPI:1922626944
Name:BYBEE, ANN LUCILLE (ASUDC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LUCILLE
Last Name:BYBEE
Suffix:
Gender:F
Credentials:ASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 E 3300 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3083
Mailing Address - Country:US
Mailing Address - Phone:801-265-8000
Mailing Address - Fax:801-265-8004
Practice Address - Street 1:1354 E 3300 S STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3083
Practice Address - Country:US
Practice Address - Phone:801-265-8000
Practice Address - Fax:801-265-8004
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353326-6008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)