Provider Demographics
NPI:1265777668
Name:TIBBS, JOLANDA CAROL
Entity type:Individual
Prefix:MRS
First Name:JOLANDA
Middle Name:CAROL
Last Name:TIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7568 ROUTE 166
Mailing Address - Street 2:
Mailing Address - City:CREAL SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:62922-2700
Mailing Address - Country:US
Mailing Address - Phone:814-952-6195
Mailing Address - Fax:
Practice Address - Street 1:7568 ROUTE 166
Practice Address - Street 2:
Practice Address - City:CREAL SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:62922-2700
Practice Address - Country:US
Practice Address - Phone:814-952-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst