Provider Demographics
NPI:1356350508
Name:MCKIBBIN, ALEX E (MS, LCPC)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:E
Last Name:MCKIBBIN
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24402 W LOCKPORT RD
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-4206
Mailing Address - Country:US
Mailing Address - Phone:630-456-2519
Mailing Address - Fax:815-230-3652
Practice Address - Street 1:24402 W LOCKPORT RD
Practice Address - Street 2:SUITE 2-B
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4206
Practice Address - Country:US
Practice Address - Phone:630-456-2519
Practice Address - Fax:815-230-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009932426Medicare UPIN