Provider Demographics
NPI:1972298883
Name:LLIBBY, MICHAEL G JR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:LLIBBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4753
Mailing Address - Country:US
Mailing Address - Phone:320-492-1787
Mailing Address - Fax:
Practice Address - Street 1:14 7TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4753
Practice Address - Country:US
Practice Address - Phone:320-492-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health