Provider Demographics
NPI:1184722530
Name:LIABOE, GARY P (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:LIABOE
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3820 CLEVELAND AVE N
Mailing Address - Street 2:# 400
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3285
Mailing Address - Country:US
Mailing Address - Phone:651-389-4400
Mailing Address - Fax:651-389-4410
Practice Address - Street 1:3820 CLEVELAND AVE N
Practice Address - Street 2:# 400
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3285
Practice Address - Country:US
Practice Address - Phone:651-389-4400
Practice Address - Fax:651-389-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 0737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN191366OtherVALUE OPTIONS
MN80174310OtherWAUSAU
MN232253OtherPACIFIC LIFE
MN6142913OtherUNITED BEHARIORAL HEALTH
MN0005947146OtherAETNA
MN8017430OtherPATIENT CHOICE
MN97095547005OtherPREFERRED ONE
MN324L6COOtherBLUECROSS/BLUESHIELD
MN232253OtherPACIFIC LIFE