Provider Demographics
NPI:1972185494
Name:KIBBE, ANGELA (CPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KIBBE
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:WADSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1700 COUNTY RD STE C
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4462
Mailing Address - Country:US
Mailing Address - Phone:775-313-0002
Mailing Address - Fax:
Practice Address - Street 1:1700 COUNTY RD STE C
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4462
Practice Address - Country:US
Practice Address - Phone:775-313-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP3266-R101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health