Provider Demographics
NPI:1932677150
Name:VANBIBER, JAMIE G (MAMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:G
Last Name:VANBIBER
Suffix:
Gender:F
Credentials:MAMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-1310
Mailing Address - Country:US
Mailing Address - Phone:903-370-9136
Mailing Address - Fax:
Practice Address - Street 1:3032 N EASTMAN RD STE 215
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5019
Practice Address - Country:US
Practice Address - Phone:903-252-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional